OPERATION DATE: 07/18/2019 SURGEON: Wayne Hellstrom, MD ASSISTANTS: 1. Christopher Koller, MD 2. Peter Tsambarlis, MD PREOPERATIVE DIAGNOSIS: Peyronie's disease and erectile dysfunction. POSTOPERATIVE DIAGNOSIS: Peyronie's disease and erectile dysfunction. PROCEDURES PERFORMED: 1. Placement of inflatable penile prosthesis. 2. Scrotoplasty. 3. Foley catheter inserted by MD SPECIMENS: None. DRAINS: A 16-French Foley catheter. IMPLANTS: 22 cm Coloplast Titan penile prosthesis, with 75 mL reservoir filled with 75 mL. ANESTHESIA: General. INDICATIONS: Mr. Corona is a 61-year-old male with history of Peyronie's disease, who for the last year has had significant curvature of his penis that was becoming refractory to PDE5 inhibitors. He had no history of penile trauma and noticed worsening erectile dysfunction. The patient also has a history of hypogonadism, treated with Androderm. On penile duplex Doppler ultrasound, he had a notable 45-degree curve dorsally. The patient was counseled about IPP as means for treating Peyronie's disease and erectile dysfunction. TECHNIQUE: After a repeat discussion of the indications, benefits, risks, potential complications, and alternatives, The patient was informed of all these and his consent was obtained. He was taken to the operative suite and placed in the supine position. After general anesthesia was induced and perioperative antibiotics were given, general area was clipped of all excess hair and prepped as per protocol. SCDs were noted to be on and in place, working, and a WHO approved timeout was then performed with Dr. Wayne Hellstrom present in the operating room. The patient was then draped in the usual sterile fashion. An Ioban membrane was placed followed by Scott's ring. A 16-French Foley catheter passed with no resistance and 10 mL of water was instilled in the balloon and the catheter was drained. Then, the catheter was capped. We began by making a 2-cm transverse penoscrotal incision dissecting down to the skin, subcutaneous tissue, and dartos fascia down to the septum between the corpus spongiosum and bilateral corporal bodies. The corpora were then exposed roughly 3 to 4 cm at the level of the penoscrotal junction bilaterally. Two parallel rows of 2-0 Vicryl stitches were applied and corporotomies were made with the Bovie followed by #15 blade. We then started on the right side and serially dilated with Hegar dilators from 10 to 14. The same procedure was performed on the contralateral side. There was no evidence of proximal and distal perforation and he was measured at 11 cm distally and 9 cm proximally for a total of 20 cm bilaterally. We performed the same procedure on the other side as well. There was no evidence of proximal or distal perforation. Total corporal length in this case was 20 cm. The decision was made to use a Titan Coloplast 20 cm IPP with no rear tip extenders and a 75 mL reservoir. As the device was being prepped in the back table, the bladder was then drained and blunt dissection to the left external inguinal ring. Subsequently, used a curved Mayo scissors superior to transversalis fascia and the floor of the inguinal canal to create a space for the reservoir. The reservoir was then successfully placed in the space of Retzius. The reservoir was then inflated with 75 mL of normal saline and a shod was applied to the tubing. The IPP then was loaded on a Furlow device and passed through the mid glandular position first on the right side than on the left. The cylinders were then placed in satisfactory position. The corporal bodies and the tubing was attached to 60 mL syringe and he had fully satisfactory erection with approximately 55 mL of fluid. The patient did have some residual curvature dorsally, although much improved from his initial ultrasound showing 45-degree curve. Residual curvature measurements were approximately 10 degrees. The device was then deflated and the corporotomies were closed and reapproximated with the stay stitches on both sides and hemostasis was achieved. Tubing between the pump and reservoir were then connected in an air-free manner and the pump was placed by blunt dissection into the posterior scrotum. The tubing and the pump were secured with 3-0 Monocryl stitch. We then evaluated the scrotum and noted that the tissue appeared to be dry with good hemostasis. We then proceeded to close the incision and performing interrupted 3-0 Monocryl stitches for the dartos layers and 4-0 Monocryl in an interrupted vertical mattress for the skin. The patient then had wound dressed with collodion, Xeroform, and a mummy wrap around the penis and scrotum. He was discharged to the PACU area for recovery, having no complications or unexpected events during surgery. ATTESTATION: Dr. Wayne Hellstrom was present and scrubbed throughout the entire procedure. DISPOSITION: The patient is to be admitted overnight for observation as well as to receive IV antibiotic dosing according to plan. The patient will have the catheter removed early in the morning for a trial of void. He was then discharged home with antibiotics, pain medications and stool softeners and will follow up with Dr. Hellstrom in clinic in 1 to 2 weeks for a wound check.