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Also known as
Penoscrotal approach, Penoscrotal junction incision, PSI (abbreviation), Penoscrotal surgical technique
Definition
A penoscrotal incision is a surgical cut made at the junction where the penis meets the scrotum, providing access to the corpora cavernosa and other penile structures.1 This incision can be performed either transversely (horizontally) or longitudinally (vertically) across the penoscrotal junction, creating an entry point for various urological procedures.2 The penoscrotal approach is designed to optimize exposure of the corpora cavernosa while minimizing visible scarring and preserving neurovascular structures.3 This surgical technique allows urologists to access the internal penile anatomy for implantation of prosthetic devices, repair of urethral strictures, or placement of artificial urinary sphincters, making it a versatile and commonly utilized approach in reconstructive urology.4
Clinical Context
The penoscrotal incision is primarily utilized in urological surgery, with its most common application being the implantation of inflatable penile prostheses (IPPs), accounting for over 80% of IPP placements worldwide.1 This surgical approach is preferred by many urologists due to its excellent corporal exposure in all patients, including those with obesity, where alternative approaches may be challenging.1,3
The clinical indications for procedures utilizing a penoscrotal incision include erectile dysfunction requiring prosthetic implantation, urinary incontinence necessitating artificial urinary sphincter placement, and urethral strictures requiring reconstructive repair.2,3,4 Patient selection criteria generally include those who have failed conservative management of these conditions and are appropriate surgical candidates without active infections or other contraindications.1
The penoscrotal approach offers several clinical advantages, including proximal crural exposure when necessary, prevention of pump migration in prosthetic implantation, minimal visible scarring, and avoidance of potential neurovascular bundle injury.1 Additionally, this approach allows for concomitant procedures such as scrotoplasty or artificial urinary sphincter placement through the same incision, which is particularly beneficial for patients requiring multiple interventions.2 The primary disadvantages include blind placement of reservoirs during prosthetic implantation and increased postoperative scrotal swelling compared to alternative approaches such as the infrapubic incision.1,4
Recovery following procedures utilizing a penoscrotal incision typically involves catheterization for a period determined by the specific procedure, management of postoperative pain and swelling, and appropriate follow-up to ensure proper healing and functional outcomes.2 Expected outcomes vary based on the underlying condition being treated, but success rates for procedures such as penile prosthesis implantation through this approach are generally high, with patient satisfaction rates exceeding 90% in many studies.1,2