Management of the anatomically complex penile implant candidate through an infrapubic incision: a review of surgical techniques and benefits.

This article provides a comprehensive discussion of 3-piece inflatable penile implant surgery when performed through an infrapubic approach in patients presenting with challenging anatomy or corporal fibrosis. The infrapubic approach is one of the primary approaches for inflatable device placement with excellent long-term functional outcomes. While the literature is rich in descriptions of infrapubic placement in the primary, uncomplicated setting, its role in the management of complex patients presenting to centers of excellence is less elucidated. In uncomplicated cases, the infrapubic approach offers several theoretical advantages including shorter operative time and quicker return to sexual function. In addition to describing specific details of our infrapubic technique and perioperative management, I discuss scenarios in which an infrapubic approach may allow for better exposure for correction of dorsal deformity, facilitate secondary surgical maneuvers such as suprapubic lipectomy, or protect existing incontinence prosthetics already in place. Specific technique and surgical pearls from our prosthetic center of excellence are reviewed for each of these challenging scenarios. Ultimately, prosthetic surgeons should be adept at placing, revising, and removing devices through both approaches so that various forms of anatomical deformity and device failures can be addressed proficiently. In addition to my own clinical reflections, a critical review was performed using the Medline database to support our statements.