The implantation process for the AMS 700™ Series involves pre-operative preparation, surgery and post-operative care. The surgical procedure usually lasts from 30 minutes to two hours, with the length of the hospital stay depending on the condition of the patient.
The surgical approach presented here is the “transverse scrotal” or “penoscrotal” approach. The name refers to the transverse incision across the high portion of the scrotum made during the procedure. The AMS 700 Series penile prosthesis also can be implanted with an “infrapubic” approach, using a vertical incision into the pelvic cavity above the penis.
The AMS 700 surgical procedure follows these steps. Caution: This information is for general educational purposes only. Refer to the Operating Room Manual and procedure videos for more detailed instructions on this surgical procedure.
Step 1: Make the Incision
Make a 2-3 cm transverse incision through the subcutaneous tissues of the median raphe of the high scrotum.
Step 2: Dissect and Retract
Dissect down through the Dartos fascia and Buck's fascia to expose the white, shiny tunicae albuginea. If using the SKW Retractor System, stabilize the incision and place the retractor hooks at 1, 5, 7 and 11.
Step 3: Make Corporotomy and Dilate
Make a small, 1.5 cm incision into the proximal corporal cavernosum tissue. Dilate first the distal corpus cavernosum and then the proximal cavernosum to create a space for inserting the penile cylinders. Make sure to go all the way to the glans. Some surgeons use the Metzenbaum or curved Mayo scissors on the first pass. Continue to dilate from 8-12 or 13 mm with sequentially larger Hegar or Brooks dilators or AMS Cavernotome tools. Repeat on the adjacent corpus cavernosum.
Step 4: Measure
Using the Furlow Insertion Tool, the AMS Measuring Tool or the AMS Proximal Tool, measure the length of each corpus, taking the proximal measurement first and then the distal. Stretch the penis slightly while measuring. Measure from the stay suture, insuring that the whole corporotomy is measured.
Step 5: Select Cylinder Size
Choose the proper cylinder size based on the measurements.
Step 6: Safety Check
Before proceeding with the implant, complete two safety checks. First, place a dilator in each corpora to check depth and evenness. This check exposes cross-over perforation and assures full corporal body dilation. Secondly, irrigate the corpora with antibiotic solution to make sure no solution comes out around the catheter.
Step 7: Insert Cylinders
Use the Furlow Insertion Tool and Keith Needle to introduce cylinders into the corpora cavernosa. Hold the four strands of suture material against the insertion tool. Insert the Furlow Insertion Tool into the distal portion of the corporal body so the front tip is palpable beneath the glans. Push the inner obturator to advance the needle through the glans. Pull needle through glans and remove from suture. The sutures now extend through the glans, allowing the surgeon to pull the cylinder into place. Repeat for the other cylinder. Close the corporotomy.
Step 8: Complete Inflate/Deflate Test
Flush cylinder tubing. Attach the 60 cc syringe filled with 55 cc of filling solution to each cylinder. Inflate cylinders to evaluate erection quality. Deflate to evaluate flaccidity.
Step 9: Implant Reservoir and Back Pressure Test
Create a defect in the transversalis fascia through the external inguinal ring. This defect provides access to the prevesical space. Implant the reservoir in the prevesical space. After implantation, fill the reservoir with the appropriate amount of filling solution. After the reservoir has been filled, perform a back-pressure test by checking to see that there is no flow of filling solution back into the syringe barrel when the thumb is removed from the syringe's plunger. If solution flows back into the syringe, the reservoir pocket may need to be enlarged or fluid needs to be removed from the system.
Step 10: Implant Pump
Use blunt dissection to form a pocket in the most dependent portion of the scrotum. Insert the pump into the scrotal pocket. Apply Allis or Babcock clamps to pump tubing through scrotal skin to hold pump in place.
Step 11: Complete Surrogate Reservoir Test
Before connecting tubing between the pump and reservoir, perform surrogate reservoir test. CAUTION: To avoid damaging the pump, don't inject the fluid into the reservoir line of the pump using a syringe. Prepare a syringe containing 55 cc of filling solution. Attach the 15-gauge blunt needle to the syringe. Flush the pump tubing with 22-gauge blunt needle on 10 cc syringe. Connect syringe with 15-gauge needle to tubing while holding syringe upright (acting as a reservoir). Unclamp the hemostat from the pump tubing. Squeeze the pump several times to inflate the cylinders and make the penis erect. Confirm that the cosmetic result is satisfactory. Note: The patient's penis should not buckle or bend and it should be rigid. Deflate the cylinders by pressing the pump's deflate mechanism. Note: The penis should be totally flaccid. All of the fluid should be stored in the reservoir during postoperative healing in order to limit the amount of fibrosis around the reservoir. Excessive fibrosis could result in the inability to completely deflate the cylinders. Reclamp the pump tubing with the tubing covered hemostat. Remove the 15-gauge needle and syringe.
Step 12: Connect Tubing and Final Inflate/Deflate Test
Connect the component tubing using AMS Suture-Tie Connectors or AMS Quick Connect Sutureless Window Connectors, after the cylinder, reservoir and pump are implanted. After all the components are connected, inflate the prosthesis to check the quality of the erection and deflate to evaluate flaccidity.
Step 13: Close and Apply Dressing
Close the incision and completely deflate the prosthesis. Apply a wound dressing.
Immediately post-op, physicians may partially inflate the cylinders for the first 24 hours to aid in hemostasis. Then, after 24 hours, the dressing is removed and the cylinders must be completely deflated.
Partial inflation also is used with patients who have bleeding that needs to be controlled with slight tamponade of the inflated cylinder. The device, however, must be deflated within five days. For other patients, the device may be totally deflated for the entire post-operative period of four to six weeks, to aid in the formation of a fibrous sheath around a full reservoir.
After three to six weeks, the physician may instruct the patient to begin cycling the device for the first time. Full inflation several times daily encourages maximum pseudocapsure development and reservoir capacity.
Four to six weeks post-operatively, the patient may usually begin using the prosthesis to have intercourse.
A reference copy of the Operating Room Manual is provided below.
Operating Room Manual
Operating Room Manual: AMS 700 Penile Prothesis