Once the corporotomy is closed, attention turns to fashioning a scrotal pouch, into which the penile pump will be placed. Our aim here is to have the pump readily accessible to the patient yet unobtrusive and concealed to the naked eye, providing a good cosmetic outcome.
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. 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 over-dilate the pouch but, rather, have it fit snugly around the penile 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. The penile pump is gently positioned into the scrotal 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.