Waynetho - Surgical notes for implant
Posted: Tue Feb 18, 2020 8:56 pm
Below are the surgical notes from my surgery. I asked my doctor for a copy and he obliged. I transcribed the notes into text editor before moving them here so there may be misspellings. For privacy I have omitted my name, personal details and masked out the names of the attending OR staff other than the first letter and last letter of each person's name.
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DATE OF OPERATION: 10/28/19
SURGEON: M... ....n, MD
ASSISTANT: S...... .....n, MD
PREOPERATIVE DIAGNOSES: 1. Erectile dysfunction.
2. Severe Peyronie's disease.
POSTOPERATIVE DIAGNOSES: 1. Erectile dysfunction.
2. Severe Peyronie's disease.
PROCEDURE PERFORMED: Placement of inflatable penile prosthesis.
ANESTHESIA: General; L. ......d, MD
INDICATIONS:
The patient is a 58-year-old white male with severe Peyronie's disease and erectile dysfunction, who is for an inflatable penile prosthesis. He understands the risks and benefits of this procedure, and has agreed to proceed.
OPERATIVE PROCEDURE:
The patient was taken to the operating room and given adequate general endotracheal anesthetic, placed into a supine position and prepped and draped in the usual sterile fashion. A Foley catheter was placed on the table.
A midline incision was made at the penoscrotal junction and both corpora were carefully dissected out, and bilateral corporotomies were performed. There was a great deal of plaque in the ventral corpora at the penoscrotal junction, which made it very hard to even make a corporotomy. I actually had to make the proximal corporotomy with the cautery on the cut mode. Once the corporotomies were performed, I was able to dilate both corpora to 12 French with some difficulty proximally, but I was able to get them dilated with Hegar dilators. The distal dilation was routine. Once they were dilated to 12, I measured both sides and they both measured 15 cm. We decided to go with the 15-cm CX prosthesis. At that point, while that was being prepared, previously a small round 65 mL reservoir had been prepared. I dissected into the left groin, perforated the medial aspect of the inguinal ring, and placed that reservoir into the retropubic space and filled it with 65 mL of sterile normal saline. Once that was done, the cylinders were ready. I placed the cylinders with the aid of a Furlow needle passer. I had a great deal of difficulty placing the right cylinders proximally. I actually had to extend the corporotomy very far proximal to actually get the prosthesis in place. Eventually, I was able to get the prosthesis to seat nicely.
I then closed both corpora with running 2-0 Vicryl sutures. A test direction was performed. There was a good rigid erection with no buckling of the cylinders. There were cylinders out to the tip of the penis with a very nice result, with minimal dorsal curvature. At that point, we deflated the cylinders. I made a quick connect between the reservoir and the pump. The pump had been placed into a scrotal pouch in the midline scrotum with the aid of a nasal speculum to make the pouch. Once the connection was made with quick connects, the device was cycled and left 80% rigid. I then closed the wound in layers after washing out the wound with 1% epinephrine lidocaine. It should be noted that, throughout the procedure, copious amounts of antibiotic irrigation were spritzed into the wound from the beginning of the procedure until the end. The skin was closed with subcuticular Monocryl and Dermabond.
The patient was awoken and transported to the recovery room in stable condition.