(130) SHAEER’S HYDRO-DISSECTION OF THE NEURO-VASCULAR BUNDLE

Neurovascular bundle mobilization (NVB) is a key-step of many reconstructive penile surgeries. This is a step that requires a lot of experience, patience, and meticulous surgical technique. Otherwise, the patient may end up with sensory deficit due to nerve injury, or arterial insufficiency due to injury of the dorsal artery of the penis. This work described hydro-dissection of the neurovascular bundle (h-NVBm) aiming at a safer and faster procedure.

H-NVBm was performed in 50 cases with congenital penile curvature or Peyronie’s deformity (h-NVB group, n=50). A matching group was operated upon without hydro-dissection (NVBm group, n=32). In H-NVBm cases, hydro-inflation of Buck’s fascia was performed prior to mobilization using 80% saline and 20% xylocaine (without adrenaline). The mixture was either injected into Buck’s fascia with a butterfly cannula inserted along the longitudinal axis of the shaft at several points, or with the blunt nozzle of a 20ml syringe, superficially applied to the surface of Buck’s fascia. In both groups, NVB was mobilized with alternating sharp and blunt dissection, aided with bipolar diathermy. Both groups were compared as regards time needed for mobilization, and post-operative sensitivity at the 6 month post-operative, subjectively evaluated on a 5-point scale.

Average duration for NVB in the hNVBm group was 3.5 minutes ± 1.4, compared to a duration of 7.3 ± 2 for NVBm group (p<0.001). Sensitivity score was higher in the hNVBm group (4.7±0.5) compared to 4.3±1 in the NVBm group (p<0.001).

Hydro-dissection of the neurovascular bundle renders the procedure relatively safer and faster. While expert surgeons may be content with classic mobilization, hNVBm can be of particular importance to new entants to of penile surgery.

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