Use of Standard Field Surgical Telescopes During Penile Implant Surgery for ED

• Background:
  Penile prosthesis implantation is a technically nuanced urologic procedure, typically performed through an open approach with direct visualization and tactile guidance. The surgeon relies on corporal dilators, sizers, and retractors to access the corpora cavernosa and prepare the space for implant insertion. While some have proposed the use of endoscopic tools (rigid or flexible telescopes) to enhance visualization, this approach has not become part of routine practice.
• Why Telescope Use Is Not Optimal in Routine Settings

Despite the potential benefits, standard field surgical telescopes present several practical and clinical limitations that make them suboptimal for routine use in most penile prosthesis surgeries:

1. Disruption of Established Surgical Workflow
   
   – Penile implant surgery is typically efficient, with a well-established workflow that emphasizes direct exposure and tactile feedback. Introducing a telescope requires a shift in technique. This disrupts the surgeon’s rhythm and slows down the procedure — without significant benefit in straightforward cases.
   
2. Minimal Added Value in Uncomplicated Cases
   
   – In primary penile prosthesis surgeries involving non-fibrotic, compliant corporal tissue, the added visualization offers limited clinical advantage. Open exposure already provides adequate visibility, and the surgeon’s tactile sense remains more reliable than an image-based assessment when dilating corpora or inserting cylinders. Thus, the use of a telescope in these settings adds complexity without enhancing safety or outcomes.
   
3. Evidence Does Not Support Routine Use
   
   – Current literature does not provide strong evidence to support the routine use of it during penile implant surgery.
   
   – While the selective use of a telescope may be beneficial in complex scenarios—such as revision surgeries, severe corporal fibrosis, Peyronie’s disease, or prior priapism—its routine application in all penile implant procedures is neither supported by evidence nor justified by clinical benefit. In these routine cases, the drawbacks—added time, cost, risk, and workflow disruption—outweigh the theoretical advantages. Thus, standard field surgical telescopes should be viewed as an adjunct for specific, high-difficulty situations rather than a default tool in prosthetic urology.

References:

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