Preoperative Preparation
To reduce risk of infection, our patients are given an antibiotic such as vancomycin 1 hour prior to beginning the surgical procedure to guard against Staphylococcus epidermidis. After the pubic hair is shaved, a 5-minute Betadine wash is performed, followed by a skin prep with Alcohol 70% and a final Betadine surgical prep. (See pictures #24, #26 of the Inflatable Penile Prosthesis Procedure)
After the patient is draped in sterile fashion, a large thoracic Vi-drape is placed on top of the sterile drapes, and the penis and scrotum are delivered through a small opening. This isolates the penis, protects the prosthesis from acquiring lint from adjoining drapes (which could act as a nidus for infection) and prevents the irrigant from soaking through the drapes. Another advantage of the Vi-drape is that it secures all the surgical drapes without the use of additional sharp towel clips. (See picture #32 of the Inflatable Penile Prosthesis Procedure)
The patient is positioned on the operating table so that flexing of the table elevates the pelvis, rotating the crus of the penis upwards toward the operator and flattening the lower abdomen. This maneuver allows for more proximal exposure of the crura (important for precise placement of cylinders) and stretches the muscles of the lower abdomen (to provide counter-traction for easier reservoir placement). A Foley catheter is inserted to identify the urethra, capped, and a Scott retractor is secured with tubing across the base of the penis. (See picture #34 of the Inflatable Penile Prosthesis Procedure)
Large blunt yellow hooks are utilized instead of the small sharp blue ones. These provide better exposure and are less likely to injure the device or gloves.
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