Placement of the Pump
Once the corporotomy is closed, attention turns to fashioning a scrotal pouch, into which the pump will be placed. Our aim here is to have the pump readily accessible to the patient yet unobtrusive, for good cosmesis. We therefore place it behind the testicles, in the fatty layer separating the tunica vaginalis of each testicle.
Some surgeons, place the reservoir first, connect it to the pump and then place the pump. I prefer immediate pump placement in the scrotum, in order to minimize contact with the patient’s skin during the time that the reservoir is being placed. This also permits tunneling of the tubing to the reservoir into the spermatic cord, anchoring the pump in the scrotum as well as hiding the tubing behind the cord.
Alice clamps are used to provide gentle traction to the scrotal fascia. A flap of scrotal fascia is developed beneath the urethra for a distance of 2 to 3 cm. Approximately 1 to 2 cm from the urethra, a small 1-cm transverse opening is made in the scrotal fascia with the Bowie electrocautery (Figure#10). A closed, long nasal speculum is pushed gently into the opening, behind both testicles, towards the bottom of the scrotum. The speculum must be kept closed, as we do not want to overdilate the pouch but, rather, have it fit snugly around the pump. Tubing from the pump to the reservoir is then tunneled along the inguinal cord, using a tubing passer, towards the region of the external inguinal ring on the side where the reservoir will be placed.
Both pump and pouch are irrigated with neomycin. All irrigant is then removed and the pump placed in the pouch. It is important to not pull too hard on the pump as that will place it too superficially underneath the skin. The opening in the scrotal fascia is then closed with a running 3-0 Vicryl suture after meticulous hemostasis is obtained.
(See pictures #161, 165, 172, 173, 174 of the Inflatable Penile Prosthesis Procedure)