Dr. Harold Reed Blog

Category Archives: Penile cavernotome for penile implant insertion

Penile Implant Infection

D. Reed,  Had to have my penile implant removed because of an infection.  Can another one be inserted?  Oscar  PS how soon?

Dear Oscar,

Generally speaking “yes”.  I would certainly allow 4 months after removal to fully heal and may I suggest penile traction or use of a vacuum erection device or Viagra like medication to help preserve your length as much as possible.  There is an operation called the “Salvage Procedure” which has been used to remove an infected implant, thoroughly irrigate out the implant bed and re-insert a new one on the table (same operation) with an 80% success rate.  This was reported in 2010  by Dr. John J. Mulcahy.  

Re-inserting another one now is a more complicated operation because of corporal fibrosis.  There are instruments to help rongeur out the channel called cavernotomes such as Carrion-Rossello and/or Uramix (Uramix, Inc., Landsdowne, PA, USA).  Improved re-implantation success in these difficult cases is also enhanced by the use of sequentially sized unique dilators, which cut through the fibrosis. These specialized instruments are called cavernotomes. The Carrion Rossello cavernotomes are sized 9–12 mm. Formerly constructed of stainless steel, a single use plastic version is now available. Teeth project from the surface similar to a wood rasp. The teeth feature backward facing sharp surfaces, which cut the fibrosis upon withdrawal. The instruments feature a bayonet configuration handle that allows the surgeon to advance them through the tissue in an oscillating fashion by alternating supination and pronation of the hand. A tunnel through the fibrosis is created upon forcibly withdrawing the cavernotome cutting the fibrotic tissue with the backward facing sharp tooth surface. The teeth allow the cavernotome to ‘walk’ forward through the tissue and seem to protect against a sudden forward uncontrolled movement. 

The Uramix Cavernotome set consists of five caverntomes made of surgical stainless steel, varying from 6 to 13 mm in diameter. The head of the Cavernotome is blunt and tapered for 1 cm. Embedded in the dilator is a 6 cm long blade with a height of 1 mm. The blade arises from a beveled surface that allows 1 mm shavings of tissue to be resected. This instrument allows drilling of a cavity within the tunica albuginea by passing enlarging, cutting dilators sequentially. An initial space must be created in the fibrotic tissue by scissors or knife before the cavernotome is introduced. The Cavernotome is advanced in an oscillating fashion similar to the maneuver described for the Carrion Rossello device. The instrument is propelled forward in small increments. The cutting blade is 1 cm proximal to the blunt tip and, if stenotic areas are encountered, it is positioned lateral to allow shaving of the stenosis. The Cavernotome can remove 1 mm strips of tissue. Pressing the narrow area with fingers on the penis facilitates shaving. Cutting can be done in a longitudinal, up and down motion or by rotating the Cavernotome.  (credit to Dr. Steve Wilson)

Occasionally grafts may be needed to cover a portion of the tunica albuginea (the capsule of the corporal body).  Often a reduced caliber (think thinner) implant cylinder may be inserted.

Cordially,

Harold M. Reed, M.D.
The Reed Centre for Ambulatory Urological Surgery | Miami
1-305-865-2000

Image result for carrion cavernotome

Carrion-Rossello Cavernotome