(061) THE ADVANCED FORK DILATOR “THE FORK FURLOW” INSERTION TOOL FOR SYNCHRONIZED IPP CYLINDER PLACEMENT
Authors: Ragheb A 
Published: December 2024

Abstract

Introduction
As dedicated implanters, we strive to develop new techniques and instruments to optimize inflatable penile prosthesis implantation (IPPI) surgery, aiming to improve postoperative results and reduce the risk of complications.

Objective
In this video, I present the advanced version of my previously introduced Fork Dilator comprising two parallel graded dilator rods attached by a single handle. The original Fork Dilator allowed bilateral corporal body dilation and length measurement in a single synchronized step during IPPI. It also ensured aligned dilation and restrained advancement, thus protecting against potential corporal crossover and perforation, respectively. This time, I introduce the more versatile Fork Furlow, which includes a double-arm introducer. In addition to the previous Fork features, the Fork Furlow serves as a double Keith needle deployment device. Its unique design allows synchronized and aligned Keith needle deployment and IPPI cylinder placement. Hence, the risk of puncturing one of the cylinders with your second Keith needle due to a missed crossover becomes almost impossible. The ultimate goal of utilizing the new Fork Furlow is to minimize the risk of intra- and post-operative complications resulting from faulty corporal body dilation, ensure implant security, and reduce intraoperative time.

Methods
Synchronized corporal dilation and sizing, as well as Keith needle and cylinder deployment, were attempted in a single step via the Fork Furlow in 12 virgin IPPI cases. The position of the Fork Furlow tines are adjusted according to the actual intercorporal distance (Fig. 1). We start by passing the tips of the tines proximally until the pubic ramus is reached (Fig. 2). Then, in a swift maneuver, the device is withdrawn and flipped upwards while being maintained within the corporal bodies and passed distally until the distal tips of the corpora are safely reached, marking the end of the dilation step (Figs. 3 & 4). Proximal and distal corporal dimensions are recorded simultaneously during the previous steps. When the IPP is ready for implantation, both Keith needles are simultaneously threaded and loaded into the Fork Furlow (Fig. 5). After passing the Fork Furlow to the glans, both needles are deployed in a synchronized fashion with a single push of the double-arm introducer (Fig. 6).

Results
The Fork Furlow technique facilitated controlled and well-aligned corporal dilation and secured cylinder placement in all our patients. We had no incidents of corporal crossovers, crural perforations, urethral violations or device compromise. Successful IPPI was achieved in a seamless and time-efficient manner.

Conclusions
I believe that the Fork Furlow dilator may be a valuable all-in-one instrument, akin to a Swiss Army knife, for IPPI that facilitates a safe and efficient procedure in virgin cases. I look forward to conducting a comparative study with conventional dilation on a larger number of patients, aspiring for the Fork Furlow to become a worthy addition to the prosthetic urology armamentarium.

Disclosure
No.