|Comparison Criteria||The No-Touch Surgical Technique||Infra-pubic Minimally Invasive & Transverse Scrotal Approach|
|Post operative infection rates||Less than 0.5% (Registry)||Historically 2 to 5% (No Registry)|
|Procedure sterility/operative/post operative bacterial contamination and infection risks||The No-Touch Technique provides complete isolation of skin from the implant, preventing bacterial contamination of the device. Any skin contact whatsoever will void the sterility of the device regardless of the location and cleanliness of the skin that is touched.||In the Infra-pubic & other approach, the implant cylinders, pump and reservoir all come into direct contact with the skin, thus allowing for bacterial contamination of the device during the procedure. In addition, surgeons’ gloves and instruments also touch the skin, providing an indirect way for bacteria to enter into the patient.|
|Surgical incision size and post operative scaring||The No-Touch Technique has a smaller incision. Using the median raphe on the midline of the scrotum, the surgical scar becomes completely concealed. No scar is seen above the penis.||The scar from the Infra-pubic & Transverse Scrotal approach is more visible on the skin above and below the penis. Hair must grow to conceal the incision, which may heal unevenly. The incision is more likely to be noticed by the partner.|
|Placement of implant pump and tubing||
The No-Touch Technique enables better positioning of the input tubing from the base of the penile prosthesis cylinder directly downwards to the pump.
The pump and tubing are placed deep inside the scrotal sac to optimize cosmetic results and make the patient look and feel natural.
|In the Infra-pubic approach, the tubing from the cylinders comes out from the back or top of the penis and is wrapped around the right side of the penis in order to place the pump in the scrotum. This results in the pump being placed higher in the scrotum, making it more visible in combination with the tubing, which remains palpable at the base of the penis. The partner is more likely to feel the pump during sexual activity.|
|Reservoir placement||Using the No-Touch Technique the reservoir is placed all the way next to the bladder, starting from an incision below the penis; a method requiring higher levels of skill and experience. In patients who have had previous pelvic surgery this may not be possible, and a second small incision may be necessary.||Infra-pubic approach provides direct placement of the reservoir, which is advantageous in patients who have had previous pelvic surgery. The reservoir is the only component that the patient never sees or feels, therefore the cosmetic benefit of this positioning is minimal. However in patients who have had previous surgery this allows the entire implant to be performed through one incision.|
|Use of surgical drain sticking out of the skin after the surgery is completed||No-Touch patients have no drain placed through the skin. This is unnecessary because the surgical openings in the penis are closed in a watertight fashion, eliminating bleeding and the No-Touch approach decreases the need for irrigation. This also results in much less post-operative swelling.||Infra-pubic & Trans Scrotal patients have a drain placed through skin because the openings in the penis are not closed completely and bleeding occurs. This results in more post-operative swelling and need for pressure dressing. The drain must be removed the day after surgery. The drain sticks out through the skin can cause post-operative soreness, is painful to remove, and requires the patient to spend the night in the hospital. Some believe that this also provides an additional route for bacterial contamination.|
|Procedure time||A No-Touch Surgery is typically performed in 45-90+ minutes depending on the complexity of the case. The surgical goals of the technique are to minimize the surgical impact on fragile penile tissue and reduce post-operative bleeding and infection risks as well as maximize outcome. Minimizing surgical time is not the priority.||Part of the procedure is completed in 30 minutes or more. The openings in the base of the penis are not closed requiring placement of a drain to remove blood, which continues to drain from the penile shaft. Pre-operative skin preparation, closure of the incision, and placement of the drain requires additional surgical time.|
|Hospital discharge – home||Patients having the No-Touch Technique are discharged from the hospital or surgery center the same day.||Patients having the Infra-pubic & Transverse Scrotal approach must spend a minimum of one night in the hospital, possibly longer, before being discharged.|