Boston Scientific AMS 700 Mode D'emploi page 11

Figure 12. Penoscrotal: Identify incision site
• If using the SKW Deep Scrotal Retraction System, place the retractor on the
patient with the large ring toward the patient's head (cephalad) and the smaller
ring towards the patient's feet (caudal) (Figure 12).
• Position the penile strap in the first slot of the retractor ring above the hinges.
• Place the sharp hook in the meatus to put the penis on stretch in the 12 o'clock
position.
• Make a high scrotal incision and move the incision onto the penis. While holding
the incision on the penis, place hooks at 1, 5, 7, 11, 3, and 9 o'clock (Figure 12).
• Laterally retract the corpus spongiosum to avoid damaging the urethra (Figure 13).
Figure 13. Penoscrotal: Retract corpus spongiosum
3. Dissect through Dartos fascia and Buck's fascia to expose the tunicae albuginea.
4. Place stay sutures.
5. Make an incision into one of the corpora cavernosa (Figure 14). As a general rule,
the corporotomy is best placed when two-thirds of the total corporal measurement
is distal to the incision and one-third is proximal. This facilitates the placement of the
cylinders, and may avoid the need to extend the corporotomy during the procedure.
Figure 14. Make corporotomy
Dilate and Size
1. Using a series of dilation tools, dilate the proximal corpus cavernosum (towards the
crus) to at least 11 mm if the cylinder tubing will exit directly from the corporotomy,
larger if the tubing will be inside the proximal corpus cavernosum. Dilate the distal
corpus cavernosum to at least 12 mm to create a space for inserting a penile cylinder.
2. After dilating one corpus cavernosum, incise and dilate the adjacent corpus
cavernosum following the same procedure (Figures 15 and 16).
Figure 15. Infrapubic: Dilate
3. Measure each corpus length proximally and distally using a corporal length
measuring device, slightly stretching the penis during this process (Figures 17 and
18). These measurements help the physician select cylinders and RTEs that fit the
patient's anatomy. If the corpora cavernosa are unevenly sized or the measuring tool
cannot reach mid glans, consider dissecting through the fibrotic tissue as needed.
Note: Measuring both directions from one of the stay sutures provides consistency.
However, when using AMS 700 LGX™ Devices, some physicians choose to measure
distally from the distal edge of a 2 cm corporotomy and proximally from the proximal
end of a 2 cm corporotomy for optimal device sizing.
Figure 17. Infrapubic: Size
Select the Appropriate Size Cylinders and RTEs
Select the appropriate size cylinders and if needed, RTEs.
Sizing
AMS 700™ CXR with MS Pump™
The proximal portion of the CXR cylinder is approximately 0.7 cm longer than the CX
and LGX cylinders. Sizing using Method A is recommended and will result in the tubing
exiting from the corporotomy.
AMS 700 CX with MS Pump and AMS 700 LGX with MS Pump
There are two methods of selecting cylinder sizes for the AMS 700 CX and LGX Prostheses.
Each surgeon's own implanting experience will determine which technique is used.
Rear Tip Extenders (RTEs)
Sizing to the 0.5 cm can be achieved, if desired, by attaching the 0.5 cm, the 1.5 cm, or
for lengths longer than 1.5 cm, by stacking one additional whole centimeter length RTE
to the 1.5 cm RTE.
Except for the 1.5 cm RTE, the RTEs cannot be stacked. They have an internal interlocking
design. Select the appropriate RTE length and attach the RTE to the cylinder, twisting
the RTE onto the cylinder to provide a tactile indication of a proper connection. The
RTE is correctly attached when the groove on the cylinder engages the corresponding
locking ring on the RTE, resulting in a smooth outer profile.
CAUTION: Do not stack the RTEs other than the 1.5 cm RTE. If other sizes of RTEs are
stacked, the locking mechanism will not engage and the RTEs may not stay connected.
CAUTION: CXR RTEs are not compatible with CX or LGX cylinders. CX/LGX RTEs are not
compatible with CXR cylinders.
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Figure 16: Penoscrotal: Dilate
Figure 18. Penoscrotal: Size
Black (K) ∆E ≤5.0