Suprapubic Lipectomy and Placement of a Three-piece Inflatable Penile Prosthesis

Area of Science:

• Urology
• Andrology
• Surgical Techniques

Background:

• Penile length loss is a concern for patients with erectile dysfunction (ED) and obesity, exacerbated by prominent suprapubic fat pads.
• Suprapubic lipectomy combined with penile implant placement offers a solution for perceived penile length reduction in this patient group.
• This study presents the surgical technique and outcomes of concurrent suprapubic lipectomy and 3-piece inflatable penile prosthesis (IPP) placement for ED and mons pubis lipodystrophy.

Discussion:

• The surgical technique involves an elliptical incision around the suprapubic fat pad, dissection, and preservation of areolar tissue to prevent seroma.
• Hemostasis is achieved using vascular clips for larger vessels, followed by IPP placement through an infrapubic approach.
• Tissue flaps are inspected for vascularity, and closure involves layered absorbable sutures and skin approximation, with the flap anchored superiorly.

Key Insights:

• Nine patients underwent the combined surgery with no intraoperative complications.
• One patient experienced a postoperative infection requiring device removal and replacement.
• Eight patients achieved successful outcomes with improved dorsal phallic length and no device-related complications.

Outlook:

• Concurrent suprapubic lipectomy and 3-piece IPP placement is a safe and reproducible surgical option.
• This technique effectively treats suprapubic lipodystrophy and buried penis in conjunction with refractory ED.
• Further studies may explore long-term outcomes and patient satisfaction with this combined approach.