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I am nearly ready to select a surgeon for a penile implant. Some prefer an infrapubic (above the penis) incision, and others do a scrotal incision. I have been leaning toward scrotal, since I am worried about damage to essential nerves with the infrapubic approach. However, the infrapubic approach is supposed to heal faster with less pain, so activation can happen sooner, and will leave less tubing in the scrotum.

Does it really matter which way surgery is done? Can anyone provide any guidance in this area?

Good question. I had scrotal last fall. The incision was across the scrotum right below the penis. In my case, the incision and stitching up was poorly done by a resident trainee and resulted in the underside of my penis being numb for months. Many here have complained about the penile numbness that I believe is the result of a lateral scrotal incision. It cuts across the skin nerves that go under the penis and in many cases leaves it without feeling. Of course, numbness makes the sex that you are going through all this for much, much less enjoyable.

The surgeon that repaired the poor work done by Dr. Morey's trainee said that he only performs infrapubic for just the reasons that you cited. It is much less painful and the recovery is faster. When I eventually have mine replaced, I'm opting for infrapubic. A less painful and shorter recovery is attractive, but I never want to take another chance with having my penis go numb. It took six months to get most of the feeling back this time. Next time that lateral scrotal incision may make the numbness permanent.

As far as the nerve risk of infrapubic, Dr. Kansas said that the nerves in question are so large and obvious at that site, that it is very unlikely that any competent surgeon would ever damage them.

I have the same question. I believe Kramer does infrapubic and Eid does scrotal with a vertical incision. There seems to be pros and cons to each one. Anyone else who can add to this, please post!!!

Hello,

Dr. Kramer strictly dose scroral approach.
Looking at videos of surgeires and comparing the two, it seems the scrotal gives the surgeon better access to measure more accurately.

https://www.google.ca/url?sa=t&source=w ... uekZl5u4Kw

I had infrapubic because of having a double hernia and the mesh that is there that way makes it easier to place resivor with less trauma to the body which equates to faster healing
Very happy with my surgeon and the results

I've had 3 vertical and one horizontal scrotal, I can honestly say the the verticals are less painful and took less time to heal. I totally understand why Dr. Carrion did the horizontal, he usually will do the vertical on the virgin guys.

Good question. I had a scrotal just about 2 years ago. Only took 1 pain pill the day after surgery. None after that. Ibuprofen took care of what little discomfort I had. I'd do it again in a heartbeat.

Hi,
According to Dr. Kramer, the infrapubic makes placing the pump more difficult.
He just posted a video about that.

Also: https://www.google.ca/url?sa=t&source=w ... nKApYLQzrA

Placement of implant pump and tubing The No-Touch Technique enables better positioning of the input tubing from the base of the penile prosthesis cylinder directly downwards to the pump.

The pump and tubing are placed deep inside the scrotal sac to optimize cosmetic results and make the patient look and feel natural. In the Infra-pubic approach, the tubing from the cylinders comes out from the back or top of the penis and is wrapped around the right side of the penis in order to place the pump in the scrotum. This results in the pump being placed higher in the scrotum, making it more visible in combination with the tubing, which remains palpable at the base of the penis. The partner is more likely to feel the pump during sexual activity.

It looks like this link is by Dr. Eid who is selling his No-Touch technique, not Kramer. A few things in Dr. Eid's description of the infrapubic approach don't square with some of my own experience and the infrapubic routine practiced by Dr. Kansas.

Dr. Kansas had to replace the botched reservoir placement put in by Dr. Morey and used the infrapubic incision for putting in the new reservoir. Dr. Morey originally had placed the pump using the lateral scrotal incision and the pump was in an OK position in the scrotum. In replacing the reservoir, Dr. Kansas removed the pump and, after hooking it to the new reservoir, put it lower in the scrotum which is much more convenient to use. Dr. Eid's article suggests that the pump placement from infrapubic is high and more visible - just the opposite of my experience.

The article says that using the infrapubic results in installing a catheter and an over-night hospital stay. Dr. Kansas always performs the infrapubic approach and never installs a catheter nor has the patient stay over night in the hospital. Maybe, catheters and over-night stays are common (I had to do both with Dr. Morey), but Dr. Kansas feels neither is necessary and are quite uncomfortable for the patient. When Dr. Kansas performed my repair, I had no painful catheter to deal with and was on my way home in a couple of hours.

Hi,
Kramer is also big fan of scrotal approach. He explains here.

https://www.google.ca/url?sa=t&source=w ... TddfPWhHew