Preserving What Matters: Why I Advocate for Tissue-Sparing Penile Implant Surgery
When I sided a debate at a Coloplast event last year, I found myself the youngest surgeon in the room challenging a long-held surgical tradition. For decades, the standard approach to an inflatable penile prosthesis (IPP) has involved "serial dilation"—the practice of using a sequence of metal instruments to widen the erectile bodies. While this is how most surgeons are trained, I am part of a shift toward a more refined, less traumatic method: Cavernous Tissue Sparing.
My preference for this technique is rooted in a simple philosophy: if we don't have to destroy healthy tissue to achieve a successful result, we shouldn't.
The Problem with "Habitual" Dilation
Many surgeons perform sequential dilation as a matter of routine, even when the patient's anatomy doesn't require it. This process involves passing multiple dilators through the corpora cavernosa (the spongy erectile tissue), which can lead to:
Unnecessary Trauma: Repeatedly passing instruments increases the risk of internal scarring and bleeding, or damage to the erectile arteries.
Loss of Natural Tumescence: Aggressive dilation can destroy the remaining erectile tissue that allows for natural engorgement and warmth during arousal.
Increased Post-Operative Pain: More surgical trauma naturally leads to a more difficult recovery for the patient.
The Dr Ross Approach: Single-Step Placement
Rather than the traditional "serial" method, I prefer a single-step technique. This involves a single, efficient passage to measure and prepare the space, followed immediately by the placement of the implant.
By avoiding unnecessary trauma, the clinical data shows significant advantages for the patient:
Better Anatomical Length and Girth: Research indicates that patients who undergo a tissue-sparing approach often achieve better immediate post-operative length and girth compared to those who undergo traditional serial dilation.
Superior Function: Data suggests that up to 89% of patients who have their cavernous tissue spared report residual penile tumescence (natural swelling) during arousal, compared to only 15% in the conventional surgery group.
Higher Satisfaction: Patients consistently report higher scores on the International Index of Erectile Function (IIEF) because the result feels more integrated with their natural anatomy.
Reduced Risk: A single-step approach reduces operative time and lowers the risk of intra-operative complications like perforations or crossovers.
When is Traditional Dilation Necessary?
It is important to note that a tissue-sparing approach is my preferred method, but it cannot be performed in every case. There are specific anatomical reasons where I must revert to traditional dilation to ensure the device is placed correctly:
Concomitant Peyronie’s Disease: Where significant plaques or curvature require more extensive reconstruction of the erectile bodies.
Corporal Fibrosis: This is scar tissue within the erectile tissue—often caused by previous infections, priapism or years of injection therapy—that prevents the tissue from expanding naturally.
Complex Revision Surgery: If a previous implant has been removed, the resulting scar tissue often requires careful dilation to accommodate a new device.
The Bottom Line
Penile prosthesis surgery should be about restoration and enhancement, not replacement. My goal is to provide an implant that offers the on-demand rigidity you need while respecting the healthy tissue you already have. By avoiding unnecessary serial dilation, we prioritise a result that is functional, comfortable, and as close to natural anatomy as possible.
Would you like to discuss the tissue-sparing technique for your procedure? Book a consultation with Dr Ross to evaluate your suitability for this advanced surgical approach.w
