Surgical Modification of Glanulopexy for the Treatment of Suprasonic Transporters (SST) Deformity at the Time and Following the Placement of Penile Prosthesis
摘要
Hypermobile glans, or supersonic transporter (SST) deformity, occurs when the penis fails to align anatomically with the penile shaft, with an estimated incidence ranging from 0.04% to 10%. This complication is most often associated with inadequate proximal dilation, which leads to the implantation of excessively short cylinders. In rare cases, a true SST deformity can be diagnosed through a physical examination. Notably, pulling the skin of the penile shaft proximally does not correct genuine glans hypermobility. In cases of undersized cylinders, the issue can be corrected through redilation and implantation of appropriately sized cylinders, which may include the addition of rear tip extenders or replacement of the cylinders. True glans hypermobility is corrected using the Ball glans hitch, a technique originally described in 1980. This method involves making a hemi-circumcision incision just proximal to the glans, extending to the tunica albuginea. Non-absorbable sutures are then placed in the distal tunica, anchoring it to the glans while preserving the cylinders. This procedure stabilizes the loose glans by attaching it to the distal tunica, thereby correcting the SST deformity. This technique has resulted in 100% of glans being positioned in their anatomical space, with 90% of patients expressing satisfaction. Ziegelmann et al. used the modified glanulopexy technique in 12 patients, achieving 100% anatomical success. The modified glanulopexy technique involves assessing the penis to determine optimal suture placement, typically on the opposite side of the deflection. Small glans or large corpora may require dorsolateral fixation. Two parallel incisions are made 2 cm proximal to the glans, and dissection proceeds to Buck fascia. After deflating the inflatable prosthesis, a 2-0 Ethibond suture is used to secure the tunica, with a 5 cm tail left for glans tensioning. A second suture is passed through the glans to secure its position. After knotting and adjusting the sutures, the wound is closed in two layers, ensuring proper coverage. The potential complications of these techniques include infection, altered penile sensation, injury to the cylinders, and patient dissatisfaction.