(326) CONCURRENT NO-SCALPEL VASECTOMY AND INFRAPUBIC INFLATABLE PENILE PROSTHESIS PLACEMENT: SINGLE-INCISION APPROACH
Authors: Kalidoss S , Fenton D , Suarez-sarmiento Jr. A , Raheem O , Perito P 
Published: December 2024

Abstract

Introduction
Patients who desire concomitant sterilization and treatment for medically refractory erectile dysfunction may benefit from a combined surgical approach involving vasectomy and inflatable penile prosthesis (IPP) placement. Traditional surgical methods often require separate incisions for each procedure, which increases overall patient recovery time and introduces potential complications associated with multiple incisions. This video details a minimally invasive no-scalpel vasectomy technique performed concurrently with 3-piece IPP placement through a single incision.

Objective
We demonstrate a surgical method that combines the no-scalpel vasectomy and 3-piece IPP placement through a single midline infrapubic incision. This approach aims to reduce the number of incision points, minimize surgical trauma, and optimize the recovery process for patients who undergo both procedures.

Methods
A 50 year-old male patient with a history of medically refractory erectile dysfunction and penile vascular disease requested sterilization and IPP implantation. Preoperative preparations included a detailed discussion of risks and benefits, home oral antibiotics, and a Hibiclens shower. The patient was placed under IV sedation and prepped in a sterile fashion. A Foley catheter was not needed as the patient voided his bladder to completion prior to the procedure. Local anesthesia was first administered via a pudendal nerve block through Alcock’s canal with 5 cc’s of mixed ropivacaine and lidocaine solution on either side. This was followed by a neurovascular bundle block and incisional block, followed by a fan block at the site of reservoir placement. A small midline infrapubic incision was made superior to the penopubic junction, only wide enough to accommodate the IPP pump. The spermatic cord and vas deferens were identified and delivered through the incision using a ring vasal clamp. The vas deferens on either side was transected and the ligated ends were secured in different fascial planes. Following the completion of the vasectomy, implantation of the IPP was performed through the same midline incision.

Results
The patient tolerated the procedure well with minimal blood loss. Postoperative pain was managed effectively, and the patient was able to ambulate without issues. The patient was discharged the following day and experienced no complications at the two week follow up visit. A post-vasectomy semen analysis performed at eight weeks confirmed complete sterility with non-motile sperm count under 100,000 per mL, meeting the American Urological Association guidelines.

Conclusions
The combined no-scalpel vasectomy and 3-piece IPP placement using a single midline infrapubic incision is a viable and effective approach for patients desiring both sterilization and treatment for erectile dysfunction. This method minimizes the number of surgical incisions required, reduces cumulative recovery time, and offers a convenient and streamlined surgical approach for these consecutive procedures, to the benefit of both patients and urologists.

Disclosure
No.