Shaeer's hydro-inflation technique for neurovascular bundle mobilization during penile surgery.

Abstract

Neurovascular bundle mobilization (NVBm) requires experience to avoid injury of the dorsal nerves and arteries of the penis. This work described Shaeer's Hydro-Inflation Technique for Neurovascular Bundle Mobilization (S-NVBm), whereby infiltration of the neurovascular bundle with saline is performed to increase safety and speed of NVBm. S-NVBm was performed in 50 cases: 21 cases of corporal rotation for congenital curvature, and 29 cases of penile prosthesis implantation with slitting of the tunica albuginea for correction of Peyronie's disease deformity (S-NVBm group). A matching group was operated upon with "classic" NVBm, without hydro-inflation (C-NVBm group, n = 32). In S-NVBm cases, hydro-inflation of Buck's fascia was performed prior to NVBm using 80% saline and 20% xylocaine (without adrenaline). The mixture was injected into Buck's fascia with the blunt nozzle of a 20 ml syringe, superficially applied to the surface. Average duration for NVBm in the S-NVBm group was 3.5 min ± 1.4 (range 1.2-7), compared to a duration of 7.3 ± 2 (range 4-11.2) in the C-NVBm group (p < 0.001); a 51.8% difference. No arterial injury was witnessed with S-NVBm group, compared to 1 case of minor unilateral arterial injury in the C-NVBm group. Sensitivity score was 10.2% higher in the S-NVBm group (mean 4.7 ± 0.5, range 3-5) compared to a mean of 4.3 ± 1 (range 2-5) in the C-NVBm group (p < 0.001). Biosthesiometry detected a mild sensory deficit in 1/50 cases of the S-NVBm group (2%) compared to 3/32 in the C-NVBm group (9.4%). Average post-operative pain score was 46% lower (2.5 ± 1.4, range 1-6) in the S-NVBm group compared to 4.6 ± 1.3 (range 2-7) in the C-NVBm group(p < 0.001). The findings herein demonstrate that Hydro-Inflation technique allows mobilization of the neurovascular bundle in a shorter time, with less post-operative pain, and with a lower risk for sensory deficit.