Dr. Paul E. Perito performs more penile implants than any other surgeon in the world. His extensive experience led him to actuate the creation of a new, safer technique which utilizes the Coloplast Titan line of biopolymer-based implements. Here he speaks openly and succinctly with the Aicube blog staff when describing the procedure.
Aicube: Good morning, doctor. Can you tell our readers about your practice and exactly what we will discuss today?
Dr. Paul E. Perito: My name is Dr. Paul E. Perito and my practice is Perito Urology, located in Coral Gables, Florida. Today I will be discussing my novel minimally invasive approach to infrapubic placement of a penile implant.
Aicube: What happens immediately prior to beginning the case?
Dr. Paul E. Perito: It should be noted that the patient will be catheterized prior to the procedure and will not have a catheter during or after the procedure.
Aicube: What is the purpose of the artificial erection?
Dr. Paul E. Perito: I begin my procedure with an artificial erection using either normal saline or a mixture of saline and lidocaine. This helps identify pathologies which may or may not have been known prior to the procedure, in essence it acts as our dilation of the corpora precluding any further dilation, but also allows for the lateral placement of stay sutures.
Aicube: How much cutting is involved?
Dr. Paul E. Perito: The infrapubic incision is a 2 to 3cm incision; pulling down on the penis helps to eliminate any penile pubic tethering. A blunt finger dissection is used to take the dissection down to the level of the corpora. Making sure to spare the small lateral vessels at the level of the incision will help to avoid postoperative penile edema.
Aicube: There are separate corporas; how do you differentiate each in surgery?
Dr. Paul E. Perito: The penis has two erectile bodies. When placing the stay sutures, a small angulated Richardson retractor is used to expose and isolate each corpora. Stay sutures help to act as my form of a Scott retractor. It is very easy to go lateral to the dorsal nerves with the artificial erection.
Aicube: Are the glands damaged during the procedure?
Dr. Paul E. Perito: After performing nearly 4000 infrapubic penile implants I have yet to see one case of glandular hypoesthesia or anesthesia that could be attributed to an injury to the dorsal nerve.
Aicube: We know that you utilize a curved #12 blade. Can you elaborate in the purpose?
Dr. Paul E. Perito: It helps to control the corporotomy size and helps keep it less than 1.5 cm. 1.5 cm corresponds to the largest diameter of the proximal portion of the Titan penile prosthesis. A 1.5 cm corporotomy usually precludes the placement of closure sutures beyond the previously placed stay sutures.
Aicube: You use a non-traditional instrument at the corporotomy stage, right?
Dr. Paul E. Perito: Yes, actually, the first thing up and down the corporotomy for me is not Metzenbaum scissors, but a Furlow inserter. The Furlow provides data on both the length and the health of the corpora. Retraction along the axis of the penis helps to preclude both proximal and distal perforations.
Aicube: What if any further dilation is necessary?
Dr. Paul E. Perito: If I use a dilator, I use one 12 Hagar dilator; curtailing dilation should eliminate any compromise to the spongy tissue thus hopefully precluding cold glands in the future.
Aicube: What about creating space for the reservoir?
Dr. Paul E. Perito: First, the transversalis fascia is perforated using a tonsil clamp in order to get my finger into a space which is then replaced with a 3 and one half-inch nasal speculum. The nasal speculum runs from cephalad to the caudad- you do not want the lockout mechanism to be bent when placed because bending it renders the lockout mechanism incompetent. The lockout is unique to the Titan and has been successfully used for many years.
Dr. Paul E. Perito continues to explain exactly how the implant is inserted into the open cavity and elaborates in the finalization of the implant process. Click HERE for part 2 of the interview with Dr. Paul E. Perito.
Dr. Paul E. Perito has traveled the globe teaching his minimally invasive approach to other surgeons. He is regarded as the foremost Erectile Dysfunction expert in the nation and, as head of Urology as Coral Gables Hospital, he has successfully performed over 3,000 penile implant procedures using his signature method.
The information contained in this article is provided by Dr. Paul E. Perito for educational purposes only. It is not intended to treat or diagnose any condition.