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Distal Corporal Anchoring Stitch

Prosthetic Implants
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Also Known As

DCAS, Distal Fixation Technique, Distal Penile Prosthesis Anchoring Technique, Distal Corporal Fixation Stitch

Definition

The Distal Corporal Anchoring Stitch is a specialized surgical technique used to secure the distal end of penile prosthesis cylinders in their proper anatomical position within the corpora cavernosa.1 This procedure involves creating a lateral sub-coronal incision on the affected side, dissecting through the Buck fascia, and making a transverse incision in the tunica albuginea to access the distal aspect of the cylinder.2 A 4-0 PDS suture is threaded through the distal cylinder ring of the implant, creating a new, properly positioned intracorporal channel.3 The suture is then passed through the distal end of this channel and through the glans, where a small cruciate incision is made at the location of the anchor stitch.4 Finally, the suture is tied with the knot buried in the glans tissue, ensuring the cylinder remains in the correct position.5

Clinical Context

The Distal Corporal Anchoring Stitch is primarily employed to address complications associated with penile prosthesis implantation, specifically distal corporal crossovers and impending lateral extrusions.1 These complications, while not as common as prosthesis infection or mechanical failure, can cause significant discomfort and potentially lead to device failure if left untreated.2

Patient selection for this procedure typically includes those who have experienced or are at risk of distal migration or lateral extrusion of the penile prosthesis cylinders.3 The surgical technique has demonstrated high efficacy, with studies reporting successful outcomes in preventing recurrence of lateral herniation in the majority of cases.1 In a series of 53 patients who underwent this procedure, no infections, wound-healing defects, or glandular sensory alterations were reported, and only two patients experienced recurrence of lateral herniation that did not require further treatment.1

The recovery timeline following this procedure is generally similar to that of standard penile prosthesis revision surgery, with patients typically resuming sexual activity after 4-6 weeks.4 Long-term outcomes show high patient satisfaction rates and effective resolution of the original complications, making this technique a valuable surgical adjunct in the management of these specific penile prosthesis complications.1

Scientific Citation

[1] Antonini G, Busetto GM, Del Giudice F, et al. Distal Corporal Anchoring Stitch: A Technique to Address Distal Corporal Crossovers and Impending Lateral Extrusions of a Penile Prosthesis. J Sex Med. 2017;14(6):767-773. DOI: 10.1016/j.jsxm.2017.04.669

[2] Perito PE, Wilson SK. The History of Penile Implants. Sex Med Rev. 2018;6(3):410-415. DOI: 10.1016/j.sxmr.2018.02.002

[3] Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med. 2007;4(4):1074-1079. DOI: 10.1111/j.1743-6109.2007.00540.x

[4] Mahdi MYA, Perito PE. Double Distal Corporal Anchoring Stitch: A Novel Technique to Prevent Distal Erosion and Migration. J Sex Med. 2022;19(1):139-145. DOI: 10.1016/j.jsxm.2021.10.013

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