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In general terms...is infrapubic or penoscrotal better? I wanted to choose peniscrotal because the incision is hidden...I know that the infrapubic makes for a faster recovery, however, I am worried that the penoscrotal would involve a more difficult operation to place the implant or that there would be more possibilities of infection...what do you think???

(Sorry for my english...im from Spain)

I preferred infrapubic as I wanted a faster recovery with less swelling and pain and to be able to start cycling and having sex as soon as possible. Also, it allows for more precise placement of the reservoir and I’m very lean and muscular and preferred a retzius placement. I don’t care about the scar as it’s only an inch long and hidden by even a little bit of hair. Ultimately though, I believe you need to go with whatever method your surgeon is best skilled and comfortable with and recommends for your particular anatomy and issues. My surgeon can do both but prefers infrapubic and recommended it for me as well.

In addition to any responses you get here, put those terms in the search function. This has been discussed repeatedly for years and you’ll find a ton of responses that you might find helpful.

Both surgical techniques have their benefits.

My own surgery was penoscrotal. I chose this method for my surgery after reading about infrapubic pumps riding high in the scrotum, even after pulling down on the pump following surgery. High riding pumps are not a problem with penoscrotal incisions as the surgeon has direct access inside to the bottom of the scrotum.

I didn't care that my recovery could take longer than an infrapubic approach, because I prioritized longterm placement of the pump.

Both surgical techniques have their benefits.

The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

https://pubmed.ncbi.nlm.nih.gov/32488210/

The good of the Penoscrotal approach
(1)
Excellent exposure of both proximal and distal corpora cavernosa even for patients with obesity or corporal fibrosis
(2)
Little risk of injury to dorsal neurovascular bundle
(3)
Pump placement is facilitated
(4)
The small scrotal incision leaves negligible scar
(5)
One incision double implant of IPP and artificial urinary sphincter is possible

The bad of the Penoscrotal approach
(1)
Blind placement of the reservoir into the space of Retzius.
(2)
Scrotal swelling can delay device activation
(3)
Risk of injury of scrotal urethra; the urethra is easily seen and can be repaired

The ugly of the Penoscrotal approach
(1)
None. There is no irreversible complication with PS incision

The good of the Infra Pubic approach
(1)
Easier, safer reservoir placement under direct vision
(2)
Diminished scrotal swelling resulting quicker pump activation
(3)
Shorter operative time in skilled hands
(4)
Incision is remote from patients with incontinence and allows abdominoplasty.

The bad of the Infra Pubic approach
(1)
Limited visualization of distal corpora cavernosa
(2)
Pump placement is not optimal with the risk of pump migration
(3)
Severe obesity and fibrotic corpora are challenging
(4)
Revision surgery after the IP approach, if required, is associated with increased difficulty and worse surgical outcomes
(5)
Scar of IP incision is visible

The ugly of the Infra Pubic approach
(1)
Risk of dorsal nerve injury, a complication from which there is no cure. While a paper in 2018 claimed that there were no reports of this complication in the literature, both Drs. Scott and Wilson sustained one in the 1980s. Wilson has also been an expert witness in six additional cases sustained with IP (all successful) that came to litigation in USA. Decreased penile sensation occurs most often following revision cases when the anatomy is not so clear.

Reference:
Otero JR, Manfredi C, Wilson SK. The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation. Int J Impot Res. 2022 Mar;34(2):128-137. doi: 10.1038/s41443-020-0319-4. Epub 2020 Jun 2. PMID: 32488210.

I read a lot of posts on FT and asked my doctor to use the scrotal approach.
He asked why I wanted it and I said I think it's less invasive.

I was very surprised to wake up with that method used.
I realize reservoir placement is more difficult, but the rest seems to be more logical to me.

I had minimal scrotal swelling and a short recovery time.

Well done ! Thanks

- Chuck

LastHope wrote:The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

https://pubmed.ncbi.nlm.nih.gov/32488210/

Girls like scars