Assembly of Components and Closure

Assembly of components

After it is correctly placed, the reservoir is filled with an appropriate amount of saline and connected to the pump. When AMS devices are used, a surrogate test is performed to check for auto-inflation and further confirm reservoir placement. This step cannot be performed when using a Mentor reservoir with the lockout valve. The foley catheter is subsequently uncapped, and urine examined. Presence of bloody urine may indicate that a bladder perforation has occurred. It is better to identify this problem at this point of the procedure rather than after the skin is closed and the foley catheter connected to a urinary drainage bag.     

The operating table is now unflexed, to a neutral position, and the point at which the tubing from the reservoir crosses the tubing from the pump is identified. Both tubes are clamped 2 fingerbreadths below the point of crossing. Tubing is appropriately trimmed and a connection made.  

(See pictures #196, 201, 202, 205 of the Inflatable Penile Prosthesis Procedure)

Closure

The surgical site is irrigated and re-examined for hemostasis. Once hemostasis is obtained, the wound is closed in 3 layers: Buck’s fascia and the scrotal pouch are closed with 3-0 Vicryl in a running fashion and the skin with a nonabsorbable vertical mattress stitch with 4-O proline. Injectable saline is used for irrigation in all cases. Once the corporotomies are closed and all of the tubing has been covered with a layer of Buck’s fascia, the drape is removed and the subcutaneous tissues and skin are closed. We use nonabsorbable sutures because we feel the patient will benefit from warm baths, starting on the 2nd or 3rd postoperative day. This helps reabsorb any swelling and edema and also keep the scrotum clean. The foley catheter is kept indwelling until the next morning. The stitches are removed after 10 to 12 days.

(See pictures #207, 209, 210, 232, 233, 234, 240 of the Inflatable Penile Prosthesis Procedure)
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