Rigi10™ Malleable Penile Prosthesis
Also Known As
Corpus cavernosum dilation, Penile corporal expansion, Cavernosal dilation, Dilation of corpora cavernosa.
Definition
Corporal dilation is a surgical procedure involving the gentle and progressive enlargement of the corpora cavernosa, the two erectile chambers within the penis. This process is a critical step in penile prosthesis implantation surgery, designed to create adequate space for the insertion of prosthetic cylinders or rods1,2. The primary purpose of corporal dilation is to ensure that the selected penile implant can be accommodated comfortably and correctly within the erectile tissues, which is essential for the successful restoration of erectile function in patients with medically refractory erectile dysfunction2.
The mechanism of corporal dilation typically involves the use of specialized surgical instruments known as dilators. Traditionally, Hegar or Brooks dilators have been employed; these are inserted sequentially with gradually increasing diameters into each corpus cavernosum, both distally (towards the glans) and proximally (towards the crus of the penis)1,2. More contemporary instruments, such as the Rigicon® HL Dilator™, are designed specifically for this purpose, offering features like dual dilation diameters on a single tool (e.g., 9-10 mm, 11-12 mm), an S-shaped body for easier handling during penoscrotal approaches, and tips engineered to achieve thorough dilation up to the glans penis, thereby minimizing potential complications like Concorde deformity (glans hypermobility)1. These modern dilators often feature tips that start at a smaller diameter (e.g., 6 mm) and gradually widen to their final size, allowing for controlled expansion of the corporal tissue with minimal force1. The procedure is performed after initial incisions (corporotomies) are made into the corpora cavernosa2.
Clinical Context
Corporal dilation is a fundamental component of penile prosthesis implantation surgery, a procedure indicated for patients with erectile dysfunction (ED) that has not responded to less invasive treatments, such as oral medications, injectables, or vacuum erection devices2.
Patient selection criteria for penile prosthesis surgery, and thus corporal dilation, typically include men with organic ED of various etiologies (e.g., diabetes, post-prostatectomy, Peyronie’s disease with ED) who are motivated, well-informed about the procedure, and have realistic expectations2. Corporal fibrosis, a condition characterized by scarring within the erectile tissue, can make dilation more challenging. Fibrosis may result from diabetes, previous intracavernosal injection therapy, Peyronie’s disease, prolonged ischemic priapism, prior prosthesis infection, or trauma2. In such cases, specialized dilators (e.g., Uramix or Mooreville dilators) or techniques, such as using Metzenbaum scissors for tissue excavation or making counter-incisions, may be necessary2.
The surgical procedure typically begins with an incision, which can be penoscrotal or infrapubic, to access the corpora cavernosa. Corporotomies (incisions into the corpora) are then made, followed by corporal dilation1,2. Dilators are carefully inserted and advanced distally towards the glans and proximally towards the crura, ensuring they are angled dorsolaterally to avoid urethral injury2. The goal is to achieve a diameter sufficient for the chosen prosthesis cylinders (e.g., AMS 700 CXR cylinders require a minimum of 9 mm dilation)2. After dilation, the corpora are measured to select the appropriate cylinder length. Complications during dilation can include corporal perforation (distal or proximal), urethral injury, or crossover (where the dilator passes from one corpus into the other)2. Careful technique and awareness of these potential issues are crucial for successful outcomes1,2.
Expected outcomes following successful corporal dilation and prosthesis implantation are generally high patient satisfaction and restoration of penetrative sexual function2. The recovery timeline involves a period of healing and adjustment, with patients typically able to use the device after several weeks. Success rates for penile prosthesis surgery are high, though potential complications like infection, erosion, or mechanical failure exist1,2.