Postby Rodsmen » Fri Jan 02, 2026 6:49 pm
Op Note signed by Jesse N. Mills, MD at 12/18/25 0843
DATE OF OPERATION:
12/17/2025
PREOPERATIVE DIAGNOSIS:
Mechanical failure of penile implant.
POSTOPERATIVE DIAGNOSIS:
Mechanical failure of penile implant.
NAME OF OPERATION:
Remove/replace multi-component inflatable implant.
SURGEON:
Jesse N. Mills, MD (P31431)
ASSISTANT:
AARON PERECMAN
SECOND ASSISTANT:
Amit Reddy, MD.
ANESTHESIA:
LMA with pudendal nerve block.
INDICATIONS:
Kevin is a 69-year-old otherwise very healthy male with a history of end-stage erectile dysfunction. He underwent uneventful placement of a penile prosthesis a couple years ago with me and then suffered a mechanical failure in intercourse where he felt an immediate loss of fluid. No pain. No signs of infection, but clearly appeared to be just a failure of the cylinders. A CT scan confirmed that he had rupture of the cylinders. We discussed that he would be a good candidate for removal and replacement. I also discussed that I would keep his reservoir; it is not that old and the malfunction appeared to be a ruptured cylinder and this __________ morbidity and allow for a quicker recovery, but also that if I had to replace the reservoir, it would be at my discretion during the case.
DESCRIPTION OF PROCEDURE:
Informed consent was obtained. He was taken to the OR and placed supine. He was induced under excellent general anesthesia. His genitals were clipped. He was washed with 5-minute 4% chlorhexidine wash and then pudendal nerve blocks were applied bilaterally. He was then prepped doubly with ChloraPrep and draped so that only the penis and scrotum were showing. The drapes were impermeable and Irrisept was placed into the urethra followed by a Foley catheter where the bladder was drained and irrigated with a little bit of Irrisept and then clamped. He was then re-prepped with ChloraPrep. Surgeon and assistant changed gloves. A surgical time-out was called, where all members of the team agreed to the procedure as well as the patient's identity. A penoscrotal incision was made. Dissection was carried down to the capsule of the pump. The pump was then released as well as I released his capsule and removed some of it just for better cosmetic appearance. There was a very small amount of clear fluid around the pump, consistent with no sign of infection. This was sent for scrotal culture per my routine, and then pump tubing was then traced down to the cylinders as well as to the reservoir. Reservoir was clamped with a rubber shod as I was still hoping to re-use it at this point and that tubing was cut. I the cut down to the cylinders bilaterally and immediately discovered the right rupture with some disruption of the PTFE layer, but it was still able to be removed in its entirety and had no tissue ingrowth. Irrigation was used copiously in the form of Irrisept as well as the urethra was tested at this point and intact. I then removed the cylinder on the left side as well and it also had a rupture very similarly, but the entire old implant came out fully intact. Copious irrigation was used at this point with a 5-minute dwell time and Irrisept as I changed my gloves. I then used the Furlow dilator to measure him at 16 and 11, which was a 2 cm upsized from his original 25 cm measurement. To that end, I went with a 24 CX implant with 3 cm rear-tip extender. I prepped this on the back table. I then also re-pressure tested the reservoir as well as irrigated it, and I still had some fluid in there, but I washed this out, replaced it, pressure tested it. We actually got a little bit of back pressure initially at about 60 mL on that side consistent with a bit of a capsular contracture but with gentle pressure was able to get him up to the full 100 with minimal back pressure at this point. My suspicion is that he always has a little bit of fluid in the implant based on his large penis size, and therefore, I felt pretty comfortable that he would have good space for that reservoir without doing anything more to the capsule. I then changed my gloves again, had another 5-minute Irrisept dwell time as I was getting the implant prep to bring onto the field. A separate Mayo stand cover was brought into the field so the implant would not touch his skin and then I placed the implant proximally and distally without any difficulty. Corporotomy sutures are shut down and I test inflated him with excellent rigidity and no curvature, no buckling. I then connected the filled reservoir tubing to the scrotal pump tubing and again tested and cycled the implant twice. He elected to go with the MS implant instead of the Tenacio after having a careful discussion about his preferences preop, and to that end, he has a 24 implant with an MS pump. Implant was left about 50% inflated. I then buried the tubing deep in the scrotum using tissue flaps that I had previously had raised using part of his old capsule. This allowed for really no show in the scrotum as well as the tubing very deeply as this was one of his issues last time, as the left tubing was a little bit more prominent and uncomfortable, and I think this problem will be fixed with this additional rotation of tissue flap to plaster it deeper into the scrotum. A drain was placed over the corporotomies, so at this point, there was no active bleeding and an additional deep layer of 3-0 Vicryl was used to provide additional tissue coverage. Dartos was then closed with a 3-0 Vicryl, skin with a 4-0 Monocryl, followed by role of interrupted nylon stitches for further wound healing integrity. Lastly, a Dermabond was placed. The drain was sewed in with a 2-0 nylon and a 4-0 Monocryl to be sewed down in the morning. A tight penile perineal dressing was applied as a last layer. He tolerated the procedure without apparent complication. Instrument, sponge, and needle count were all correct at the end of the case.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Less than 25 cc.
DRAINS:
14-French Foley and a 7 JP.
FINDINGS:
Ruptured cylinders. Reservoir was intact and pressure tested.
SPECIMENS:
Removed: Implant and scrotal wound culture.
INTRAVENOUS FLUIDS GIVEN:
A L of lactated Ringer's.
URINE OUTPUT:
Not recorded.
Jesse N. Mills, MD (P31431)
67 yrs. gay married 32 years, totally open. Dr. Jesse Mills UCLA Revision after 2yrs, 12-17-25. From AMS700CX 24cm+1cm to 24+3cm See
viewtopic.php?t=23367#p219859 or BionicRod.com
