PREOPERATIVE DIAGNOSIS: *** Erectile dysfunction due to arterial insufficiency Corporo-venous occlusive erectile dysfunction Combined arterial insufficiency and corporo-venous occlusive erectile dysfunction Erectile dysfunction following radical prostatectomy Erectile dysfunction following radical cystectomy PREOPERATIVE DIAGNOSIS Same PROCEDURES PERFORMED {bdfprocedures:44708} PRIMARY SURGEON : ***, MD ASSISTANT: ***, MD FINDINGS: *** hydrocele with *** fluid, total *** cc. ANESTHESIA General EBL: Minimal COMPLICATION: None Condition: Stable @BDFOPHEADER@ Implant details: Cylinders: *** Rear tips (right): *** Rear tips (left): *** Reservoir volume: *** Reservoir side: Reservoir location: @ORIMPLANT3@ OPERATIVE TECHNIQUE Informed consent was obtained. The patient's identity was confirmed in the pre-operative holding area, and he was brought back to the operating room by anesthesia. He was sedated and intubated. Broad-spectrum IV antibiotics were administered prior to incision. The patient was positioned supine and frog-legged with one pillow supporting his knees and another pillow supporting his heels. Foley catheter was placed and removed once the bladder was empty. He was clipped, and a chlorhexadine scrub was performed. He was then prepped with chloraprep and once this dried he was draped. Skin was prepped once again with chloraprep, and gloves were changed. A 21-gauge butterfly needle was used to induce an artificial erection with 120mL of lidocaine/injectable saline. There was no curvature, narrowing or other abnormality. {bdfippincision:44235} Dissection was carried through Dartos fascia. Corpora were exposed, and corporotomies were made. A corporotomy stay suture was placed with 2-0 Vicryl UR6. Measurements were taken. Proximal and distal corpora were irrigated with antibiotic solution. We confirmed that there was no crossover or urethral injury. While the device was prepped, the space for the reservoir was created. It was filled, and we confirmed that there was no back pressure. We then placed cylinders in the standard fashion. Cylinders were inflated. Distal tips were well positioned in the mid glans. There was no bulging at the corporotomy sites. There was no curvature. ***Modeling was performed. The cylinder input tubing was clamped after being filled to the maximum, and while maintaining manual pressure on the corporotomy sites, the curve was modeled and held for 60 seconds. This was repeated, and after the second modeling attempt the penis was *** straight. Corporotomies were closed in a running watertight fashion with vicryl. Pump was placed in the scrotum. Connections were made. Device was cycled several times, and functioned well There was excellent hemostasis. Drain was placed on the same side as the reservoir. Dartos was closed in several layers in a running fashion. Skin was closed in an interrupted fashion with 3-0 chromic and covered with skin glue. A "Mummy wrap" dressing was applied over the penis and scrotum with Kerlex. The device was left fully deflated. The procedure was tolerated well. There were no immediate complications. PLAN Admit for observation Anticipate discharge today if pain well controlled and voiding successfully Continue IV abx while in house If he stays overnight: Remove Foley @ 4am POD1, ensure adequate voiding prior to discharge Remove drain on AM rounds if output < 20cc/shift If discharged today: Remove drain prior to discharge Remove mummy wrap in AM Follow-up: *** weeks for a post-op check Do not use IPP until f/u appt No bathing/swimming 4 weeks (showers are OK)