These images, intended for a medical audience and educational purposes, may be intense for those unaccustomed to surgical scenes. The surgery you see on this video was performed by Prof. Gabriele Antonini.
Using the minimally invasive approach, all components of the three-piece hydraulic prosthesis are implanted through a 2 cm incision at the base of the penis. The procedure can be safely performed under general, spinal, or local anesthesia in less than 15 minutes. Patients typically resume sexual activity within 4 to 6 weeks.
Description of the Technique
After performing hair removal in the operating room, the skin is cleaned and disinfected for 10 minutes with a povidone-iodine solution. Cefazolin is administered intravenously. The first step is inducing an artificial hydraulic erection by injecting 0.9% saline solution into the corpora cavernosa. This identifies any pathologies requiring correction, such as curvature or “hourglass” deformities, while facilitating dilation and ensuring the correct placement of sutures alongside the dorsal nerve.
The average time to complete the implant is 15 minutes, compared to 50 minutes using the peno-scrotal approach, benefiting postoperative pain reduction and lowering infection risk to near zero, as no urinary catheter is used and the scrotal skin, prone to bacterial colonization, is avoided.
The minimal invasiveness in corporotomy and pump placement significantly reduces hematomas and seroma formation. If these occur, they are managed with a drain left in the scrotal pouch for 24-48 hours postoperatively. This access also provides easier positioning of the reservoir in either the para-vesical or ectopic location above the transversalis fascia.
Postoperative discomfort is minimal, allowing patients to manage the scrotum and activate the hydraulic system as early as 7 days post-surgery, resuming sexual activity within a month. Early activation maximizes the potential of the AMS LGX model, which enables an increase of at least 2 cm in both length and width over time.
After surgery, a single dose of gentamicin and a 10-day course of cefazolin are administered. The technique is quick, safe, and aesthetically optimal, with a small 2.5 cm incision.
