DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Eroded penile prosthesis.
2. Traumatic hypospadias.
3. Peripheral vascular disease.
4. Severe diabetes mellitus.
POSTOPERATIVE DIAGNOSES:
1. Eroded penile prosthesis.
2. Traumatic hypospadias.
3. Peripheral vascular disease.
4. Severe diabetes mellitus.
OPERATION PERFORMED:
1. Removal of penile prosthesis, complete 3-piece.
2. Cystotomy and suprapubic tube insertion.
3. Cystoscopy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
DESCRIPTION OF OPERATION: The patient was brought to the operating room suite. He had preoperative antibiotics. The patient was given anesthesia and prepped and draped in the dorsal lithotomy position. The patient had his Foley catheter removed and a clean catheter was placed in the field. His penile and scrotal region was shaved with a sterile razor. A transverse scrotal incision was made, and using the Lone Star retractor, blunt and sharp dissection was used to dissect down to the scrotal tubing and dissect the corpora. Care was taken to prevent any injury to the urethra in the midline. Cautery was used to dissect onto the tubing for the pump. The pump was pulled up and completely freed. This was followed across to the right side where the reservoir was dissected.
Once the tubing had been dissected, this was clamped and cut and the reservoir was drained. Cautery was used at the neck of the reservoir and the reservoir was removed. The tubing was then all separated and the pump was also separated and handed off the field. A piece of tubing was found to the corpora on each side. The corpora were opened laterally in a lengthwise incision with electrocautery. Care was taken to avoid the midline. A right angle was then used and passed around the corporal pontoon. This was removed and a rear tip extender was noted.
The left side was then removed in a similar fashion and the rear tip extender was also removed. The patient had very minimal bleeding from this. The corpora were then reapproximated on each side with interrupted figure-of-eight PDS sutures with 2-0 suture. The patient had these areas irrigated, specifically on the left side, where he had the large erosion. He then had a Penrose drain placed and the subcutaneous tissue was reapproximated with interrupted sutures. The skin was then closed with a running 4-0 Vicryl suture. The Penrose was brought out through a separate stab incision and secured to the skin using Vicryl loose suture.
The patient then had a cystoscopy revealing moderate BPH. His bladder appeared normal; although, there was some inflammation, likely from the indwelling Foley catheter. This was then removed. The patient then had a Lowsley retractor passed through his urethra. This was retracted to the anterior wall. A knife was used and an incision was made in the midline. The patient had a cystotomy created and the Lowsley retractor was passed through this. The Lowsley retractor was opened and a 16 French Foley catheter was then grasped and brought into the bladder. The balloon was inflated with 10 mL of sterile water. This was noted to drain the bladder. Cystoscopy was used to confirm the balloon location in the bladder. This was secured to the skin using a figure-of-eight silk suture and this was tied around the catheter. The patient had fluff dressings placed and was taken to the recovery room in stable condition.
