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Definition
The Ghattas Technique is a specialized surgical procedure in urology that involves constructing a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder to increase its diameter for patients with larger corporal bodies.1 This innovative approach addresses a significant limitation in penile prosthetic implantation where standard malleable prostheses (maximum 13 mm diameter) are insufficient for patients requiring larger diameters.2 The technique involves wrapping polypropylene mesh around the prosthesis and modifying the number of layers to achieve optimal sizing, thereby preventing complications such as penile shortening, prosthesis instability, and breakage that can occur with undersized implants.1
Developed by Dr. Osama Ghattas and colleagues, this technique provides a solution for cases where the standard malleable prosthesis diameter (13 mm) is inadequate for the patient’s corporal body size.1 By using a biocompatible polypropylene mesh—the same material safely used in hernia repairs—the procedure allows for customization of the prosthesis diameter while maintaining functionality.1 The number of mesh layers can be adjusted according to the specific requirements of each patient, offering a personalized approach to penile prosthetic implantation.1
Clinical Context
The Ghattas Technique is primarily used in patients with organic erectile dysfunction (ED) who require penile prosthetic implantation but have larger corporal bodies that would be inadequately served by standard malleable prostheses.1 Patient selection criteria include those with intracorporal diameters exceeding 13 mm after dilation, particularly patients who have experienced unsatisfactory outcomes with standard prostheses, including penile shortening, floppiness, or prosthesis breakage.1
The surgical procedure begins with a ventral incision to expose the corpora cavernosa, followed by placement of bilateral sling sutures on both cavernous bodies.1 A corporotomy incision of approximately 2.5 cm in each corporal body provides sufficient access for dilatation.1 After measuring intracorporal dimensions and performing irrigation with an antibiotic solution, the surgeon determines whether the Ghattas Technique is necessary based on the corporal diameter.1
For intracorporal diameters more than 13 mm after dilatation, a sheath of polypropylene mesh is constructed and wrapped around a 13-mm penile prosthesis cylinder.1 The number of layers of mesh is modified to fit the apparent size of the corporal body, and the mesh is fixed to the prosthesis using polypropylene stitches.1 After placing the ensheathed penile prosthesis cylinder within the corporal body, the surgical wound is closed in layers and the penis dressed with an elastic bandage.1
Clinical outcomes have been promising, with significant improvements in erectile function as measured by IIEF-5 scores (increasing from 8.3 to 24.6, P < 0.001) and high patient satisfaction (mean EDITS score of 94.9).1 The technique has shown particular efficacy in revision cases where previous implantations failed due to diameter limitations.1 Postoperative complications are minimal, with some patients reporting mild to moderate penile pain (17.4%) that resolves gradually through follow-up, and delayed ejaculation (8.7%).1
The Ghattas Technique offers two primary benefits: optimization of the prosthesis diameter and more comfortable positioning of the prosthesis in the penis, together achieving greater satisfaction for the patient.1 While the malleability of the prosthesis may decrease slightly depending on the number of wrapped layers, this reduction is not significant enough to interfere with functionality.1