(024) The “Fork” Dilator for Bilateral Synchronized Corporal Dilation During Penile Prosthesis Implantation
Authors: Ragheb A 
Published: March 2024

Abstract

Introduction
Serious implanters constantly strive for new approaches and instruments to optimize penile prosthesis implantation (PPI) surgery, subsequently improving postoperative outcomes while reducing complication risk.

Objective
I introduce a novel corporal dilator coined as “The Fork Dilator” or “The Fork” (patent pending) in resemblance to the “2-tine carving fork”. It comprises 2 parallel graded dilator rods (size 10 mm each) attached by a single handle that allows adjusting the distance between both rods. (Figure 1) The objective of this unique design is to allow bilateral corporal body dilation and measurement in a single synchronized step during PPI. Moreover, the fact that the twin rods are fixed parallel to each other makes them serve each other indirectly as guides ensuring proper alignment during advancement through corporal cavities. Hence, never could they meet or separate along the way. At the same time, their fused design turns each rod into a bridle restraining any exaggerated advancement of its twin thus protecting against potential perforation. The ultimate goal of utilizing “The Fork” is to reduce intraoperative time while minimizing the risk for intra and post-operative complications resulting from faulty corporal body dilatation.

Methods
The Fork was utilized in 21 virgin cases of PPI (18 inflatable and 3 malleable). Apart from the steps of corporal dilation and sizing, all surgeries were performed in the regular fashion. Synchronized corporal dilation and sizing were attempted in a single step via the Fork as follows. After opening our corporotomies, we adjust the position of the Fork tines according to the actual intercorporal distance. (Figure 2) Once ready, we start by passing the tips of the tines proximally till the pubic ramus is normally reached. (Figure 3) Then in a swift maneuver, the device is withdrawn and flipped upwards while being maintained within the corporal bodies and passed distally until the distal tips of the corpora are safely reached, marking the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 dilatation step. (Figures 4–6) Proximal and distal corporal dimensions are recorded simultaneously during the previous steps. A video for the surgical technique using The Fork prototype is available for further elaboration.

Results
The Fork technique facilitated controlled and well-aligned corporal dilatation in all our patients. We had no incidents of corporal crossovers, crural perforations, or urethral violations. Successful PPI was achieved in a seamless and time-efficient manner. For the inflatable implants, we utilized both the Rigicon Infla10 AX® (n=12) and the Coloplast Titan® (n=6) while the Rigicon Rigi10® (n=2) and Coloplast Genesis® (n=1) were our choice for the malleable ones.

Conclusions
I believe that the Fork dilator is a new tool that may facilitate safe and efficient PPI in virgin cases. We look forward to conducting a comparative study to conventional dilatation on a larger number of patients aspiring the Fork to be worthy of addition to the prosthetic urology armamentarium.

Disclosure
No.