Penoscrotal Approach

The penoscrotal approach is clinically indicated for patients with erectile dysfunction who have failed or have contraindications to less invasive treatments such as phosphodiesterase-5 inhibitors, vacuum erection devices, or intracavernosal injections, and who opt for surgical management with an inflatable penile prosthesis.¹ Patient selection is critical and involves thorough counseling regarding realistic expectations, potential risks (e.g., infection, mechanical failure, penile length changes, injury to adjacent structures), and benefits of the procedure.¹ Contraindications include active infections (especially urinary tract or genital skin infections), unwillingness to undergo further surgery for revisions, and unresolved urination problems.¹

The surgical procedure using the penoscrotal approach involves specific steps: patient positioning (frog-leg position), sterile preparation and draping, and catheterization.¹ A self-retaining retractor is typically used to optimize exposure.¹ The incision is made transversely below the penoscrotal junction, followed by dissection to the corpora cavernosa.¹ Corporotomies are then performed, and the corpora are dilated to accommodate the prosthesis cylinders.¹ The pump is typically placed in a dependent scrotal position, and the reservoir is placed in the retropubic space (space of Retzius), though this is done blindly with this approach, which is a noted disadvantage alongside potentially increased scrotal swelling compared to an infrapubic approach.¹ Expected outcomes generally include restoration of erectile function sufficient for intercourse, though patients should be counseled on potential changes in penile length or sensation.¹ Post-operative care involves pain management, antibiotics, and instructions on device cycling after an initial healing period.¹