VS-3-2 Abdominoplasty and PP Insertion: A New Standard Approach for Obese Patients?

One-third of adult men are obese and profound sexual dysfunction is quite common in them. Penile prosthesis implantation has been proven to be an effective option for patients that do not respond to non-surgical treatments. Together with an abdominoplasty, it could be an alternative treatment in obese patients to improve satisfaction and facilitate sexual intercourse. For us, this is the new gold standard. There are two different approaches to performing this surgery: with both penoscrotal and abdominal approach and with an infrapubic approach. In the first case, we start the surgery inserting a penile prosthesis with a standard scrotal approach and then we perform the abdominoplasty. We make a dissection of the suspensory ligament, a step that we do only when we place a penile prosthesis. One of the disadvantages of this approach is the realization of two incisions. The advantages are a lower exposure of tissues with a lower risk of infection and the simplification of the pump placement. It is mandatory to place two drainage systems and to perform a good closure of the subcutaneous tissue in order to avoid lymphoceles. As for the infrapubic approach, we proceed to perform the abdominoplasty first and then the placement of the penile prosthesis with just one incision. It is important to wash the surgical cavity properly with a mix of chlorhexidine gentamicin and rifampin. On the other hand, due to the higher tissue exposure, there is more risk of infection and a higher lymphocele rate. The postoperative considerations that we follow are a "semi-Fowler” position for 24 hours, the suction drainage systems for 48 hours and wearing an abdominal binder for 2 weeks.