Penile Frenuloplasty

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  • The penile tip has a ventral curvature with erection
  • The frenulum can tear and bleed with intercourse

 

Why is it done?

  • To straighten out a curved penis which is pulled ventrally by a tight frenulum

 

How is it done?

  • This is done under general anesthetic or a penile block.
  • A horizontal cut is made through the tightest part of the frenulum
  • The incision is then closed by opposing edges in the vertical plane.
  • Dissolvable sutures are placed between the 2 remaining edges.

A local anaesthetic is injected into the base of the penis thus giving postoperative pain relief for the next 4-6 hours

Complications

  • Any anaesthetic has its risks and the anaesthetist will explain such risks.
  • Bleeding is a common complication.
  • With any subsequent erections postoperatively, the sutures may pull out causing an opening of the wound with subsequent bleeding.
  • An infection of the wound can occur

NB! Each person is unique and for this reason, symptoms may vary

 

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Wes Frenuloplasty

Copyright 2019 Dr Jo Schoeman

Penile Shunt / Aspiration

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Treatment of a low-flow priapism.

 

Why is it done?

  • Prolonged painful erections lasting > 4-6 hours.
  • Usually associated with drug use.
  • Usually associated with intracavernosal administration of Erectile Dysfunction drugs.
  • You would have conservative measures, i.e. Icepacks, Pseudo-ephedrine tablets etc.

How is it done?

  • This procedure is done under general anesthetic.
  • Supine position.
  • The penis is surgically prepared.
  • 2 large-bore cannulas are placed through the glans penis into the Corpora Cavernosa.
  • Old clotted blood is drained until flaccid.
  • The corpora is rinsed with saline.
  • A weak mixture of Ephedrine may also be used to rinse the Corpora Cavernosa.
  • Should this not be effective, a scalpel can be placed to cut the CC to create a short circuit with the CS.
  • This may have erectile dysfunction as a result.
  • If the priapism is deflated, the procedure is completed by placing an Indwelling Catheter and an elasticated compression bandage for a few hours.

What to expect after the procedure?

  • Any anesthetic has its risks, and the anesthetist will explain such risks.
  • Bleeding is a possible complication.
  • Your catheter will be removed on Day 2-3.
  • Recurrent priapism requiring more than 1 intervention.
  • The possibility of permanent Erectile Dysfunction.

What next?

  • Dressings should be kept dry for the initial 72 hours after surgery and soaked off in a bath thereafter.
  • The catheter will be removed after 3 days.
  • Patients should schedule a follow-up appointment with Dr Schoeman 4-6 weeks after the procedure.
  • An arteriogram may be recommended to exclude AV-Fistulas.
  • There will be signs of bruising for at least 10 days.
  • PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS and RETURN OF PRIAPISM.

 

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Wes Penile Shunt Aspiration

Radical Penectomy

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Complete removal of penis with creation of a perineal urethrostomy.

 

Why is it done?

  • Confirmed penis cancer, infiltrating most of the penis.
  • Cancer involving the base of the penis.
  • Lymph nodes are palpable, could also be draining pus.

How is it done?

  • This procedure is done under general anesthetic.
  • Supine position.
  • The whole penis is removed, sparing the proximal urethra, (if not involved).
  • The urethra is opened onto the perineum (perineostomy).
  • Hemostatic dressings are placed.
  • Specimen is sent to a histopathologist.
  • An indwelling catheter will be inserted.
  • A dressing is then applied, which should be removed after 72 hours.

What to expect after the procedure?

  • Any anesthetic has its risks, and the anesthetist will explain such risks.
  • Bleeding is a possible complication.
  • Your catheter will be removed on Day 3.
  • Long-term risk of a urethral opening stenosis.
  • An infection of the wound may occur and requires immediate attention.
  • DANGER SIGNS: A wound that swells immediately, fever, and puss. Contact Dr Schoeman or the hospital immediately as this occurs in up to 15–20% of all cases.

What next?

  • Dressings should be kept dry for the initial 72 hours after surgery and soaked off in a bath thereafter.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • The catheter will be removed after 3 days.
  • On discharge, a prescription for 4 weeks of Antibiotics will be issued for patients to collect
  • Betadine sit baths are advised.
  • Patients should schedule a follow-up appointment with Dr Schoeman 4-6 weeks after the procedure.
  • At this stage you will be scheduled for a superficial and deep inguinal node dissection.
  • If your nodes are positive for cancer, Radiation and Chemotherapy will be discussed by an Oncologist.
  • There will be signs of bruising for at least 10 days.
  • PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

Complication of Inguinal Node dissection

  • Any anesthetic has its risks, and the anesthetist will explain such risks.
  • Bleeding is a possible complication.
  • Longterm leg lymphedema, requiring compression stockings.
  • Lymphoedema requires attending Lymphoedema Clinics.
  • Wound dehiscence’s and poor healing.
  • An infection of the wound may occur and requires immediate attention.
  • DANGER SIGNS: A wound that swells immediately, fever, and pus. Contact Dr Schoeman or the hospital immediately.

 

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Wes Penectomy Radical

Supra-Pubic Catheter

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Invasive placement of a silicone tube in a percutaneous supra-pubic puncture site. This is secured inside the bladder (with a balloon) and attached to a drainage bag on the outside, in order to drain an obstructed bladder.

Why is it done?

  • This can be placed as an emergency for patients in acute urinary retention
  • Patients requiring long term catheterization especially spinal cord injury patients
  • Failed urethral catheterization
  • Severe prostate obstruction
  • Urethral strictures
  • Severe sepsis of the urogenital area where diverting urine away from the area is advisable
  • Urethral catheterization impossible

 

How is it done?

  • Usually done under general anesthesia.
  • This is done as a sterile procedure; therefore, the genital area and suprapubic area will be cleaned with a non-abrasive dis-infectant.
  • A flexible cystoscopy will be placed to inspect the bladder, allow filling with saline and visualize the puncture with a cannula from the skin (outside)
  • A 1cm incision is then made in the midline of the lower abdomen, approximately 2cm above the pubic bone
  • An appropriate size catheter (14-16Fr) will be inserted using a trocar method
  • Correct placement is confirmed with the cystoscopy (direct vision)
  • An anchoring balloon will be inflated with 10cc of sterile water.
  • A drainage urine bag will be attached
  • The catheter will be secured to your leg. (check that this is always secured)

 

Complications

  • Side effects from a general anesthetic.
  • Bleeding from the wound site. (Anti-coagulants should have been ceased a week prior)
  • Depending on the size of your bladder a possible bowel injury could occur, the odds of this happing will be discussed with you prior to your procedure.

 

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Wes Catheters Suprapubic Catheter CHANGE

Copyright 2019 Dr Jo Schoeman