Miko24
Guru
PROCEDURE: After informed consent was obtained the patient was brought to the operating room and placed on the table. He was given a general anesthetic and left in a supine position. He was prepped and draped in usual sterile fashion. A time-out was called and he was on IV antibiotics. On examining the penis he has significant bruising from previous procedures. There is a raised soft tissue lump on the right mid shaft, likely corresponding to where he underwent previous injections. This is freely mobile and does not appear to be infected. The erection is not fully firm, and I would approximate it at a 60-70% erection. There is some compressability and malleability to the penis. A 16 French Foley catheter was placed into the patient's bladder and the balloon was inflated to 10 cc of saline. The bladder was emptied with suction and the catheter was clamped. I then performed a T shunt on the right-hand side by advancing a 10 blade through the glans and into the distal corpus cavernosum, with the blade facing dorsal. Once I felt the pop the blade in the corpus cavernosum I advanced it another cm, turned the blade 90 degrees lateral and withdrew it. At 1st there was sluggish return of dark venous blood, but quickly there appeared to be bright red arterial blood. I advanced a 7 mm Hegar dilator through the opening in the glans and into the distal corpus cavernosum. This was advanced carefully along the longitudinal axis of the corpus cavernosum to create a tunnel all the way down the base of the penis. When the Hegar dilator was withdrawn there was prompt return of bright red oxygenated blood. I compress the penis and was only able to achieve partial detumescence after working for some time. I then did the identical procedure on the left-hand side, again performing a T shunt procedure and tunneling with the 7 mm Hegar to the base of the penis. The left corpus cavernosum appears more indurated than the right side. Again I was able to get return of oxygenated blood from the T shunt through the glans. I irrigated each corpus cavernosum to the glans with saline to try to break up any additional trapped venous blood. I then reconstituted 10 mg of phenylephrine in 10 cc of saline, for concentration of 1000 micro g per cc. I then drew up 0.5 cc of this mixture and diluted it with 10 cc of saline to treat the concentration of 500 micro g in 10 cc. This was then irrigated into the right corpus cavernosum. I then did the same on the left. I continue to trying express any additional venous blood from the corporal bodies at this point it was evident that the residual tumescence was simply due to induration and erythema due to the ischemic injury, and that we had restored oxygenated blood flow to the corpus cavernosum bilaterally. I then repaired the glans incisions bilaterally using a 4-0 Vicryl suture in a locking fashion. Antibiotic ointment and a gauze dressing were placed on the glans.
54435 - would this be correct?
Thank you
54435 - would this be correct?
Thank you