The plenary on Sunday morning at AUA2023 was devoted to presentations on sexual medicine. Within that session, Drs Mohit Khera, Matthew Ziegelmann, and Jeffrey Loh-Doyle presented semi-live surgeries that showcased novel techniques and newly introduced tools that can be used during penile reconstruction.

Dr Khera demonstrated a step-by-step guide on how to fixate the penile prosthesis reservoir to the fascia in order to prevent migration and herniation of the reservoir after the ectopic, submuscular reservoir is placed. The video clearly shows the ease and reproducibility of this technique. After exposure of the inguinal canal, a right-angle clamp is passed through the fascia of the external ring and the tubing of the reservoir is grasped so that the tubing itself is fixated to the fascia. The reservoir is then placed in a low submuscular location using a standardized technique. In an initial series of 31 patients, no patients experienced reservoir-related complications including herniation or migration. Based on the demonstration, this technique adds no significant surgical time to widely used submuscular reservoir placement techniques and may prevent the future need for revisional surgeries.

In the second video of the session, Dr Ziegelmann presented his technique of correcting volume loss deformities caused by Peyronie’s disease with extratunical grafting. After explaining the technique and indications, correction of a patient with intact erectile function with left lateral and dorsal curvature was shown. A plication procedure was first performed followed by extratunical grafting. After plication, the resulting erection was straight but the indentation was exacerbated, which is a commonly seen consequence of plication surgery. After identification and measurement of the deformity, Tutoplast pericardium graft is prepared and Buck’s fascia and the neurovascular bundle are partially elevated so that the graft can be secured underneath Buck’s fascia to minimize the palpability of the graft. The graft depth can be tailored depending on the depth of deformity, and additional segments of graft can be used to correct any remaining indentation. Buck’s fascia is then reapproximated over the graft and the incision is closed. Overall correction of the deformity is excellent and shows the importance of including this technique in the armamentarium of effective Peyronie’s disease treatments.

For the last semi-live surgery of the session, Dr Loh-Doyle demonstrated use of the newly released disposable, single-use Furlow measurer and penile prosthesis insertion tool during placement of a 3-piece inflatable penile prosthesis. Due to reports of contaminated Furlows as a possible nidus for device infection, the single-use Furlow was developed and introduced to the market this spring. Through an infrapubic incision, surgical technique and specific nuances of using the disposable Furlow were shown and compared to the reusable Furlow. When compared to the traditional Furlow, the new Furlow has a larger diameter, a more tapered tip, and smoother shaft, which allows for easier corporal dilation. The numerical graduations are clearly visible and the locking obturator was noted to have great feedback. During device placement, the Furlow is shown smoothly sliding into the corpora. In addition to showing the newly released Furlow, several other techniques were shown including accurate placement of penile prosthesis pump placement, alternate reservoir location in the lateral retroperitoneum in patients with hostile pelvic anatomy, and use of dilute chlorhexidine gluconate in sterile water as an irrigation.

The field of penile reconstruction has seen transformational changes over the past decade, and the semi-live session highlighted several important developments that have been adopted by the sexual medicine and reconstructive communities.