Infrapubic vs Penoscrotal Approach in Penile Implant Surgery
What are the infrapubic and penoscrotal incision approaches in penile implant surgery, and how do they differ? Which approach suits which patient — an informative comparison.
Penile implant surgery can be performed through two different incision approaches: penoscrotal (at the junction of the penis and scrotum) and infrapubic (above the penile base, just below the pubic bone). Both are widely used worldwide and are safe in the right hands. Knowing the differences helps you ask the right questions at your consultation.
What is the penoscrotal approach?
The incision is made where the penis meets the scrotum. Its main features:
- Direct access to the scrotum, making pump placement straightforward.
- A wide view of the penile base — often preferred in revision cases with scar tissue.
- The scar stays within the scrotal area and is not visible from the outside.
- The reservoir is placed through the same incision into the space behind the lower abdominal wall by tactile technique.
What is the infrapubic approach?
The incision is made above the penile base, just below the pubic bone. Its main features:
- The reservoir of an inflatable implant is placed under direct vision — a safety advantage, particularly in patients with previous abdominal surgery.
- Operative time is generally short in experienced hands.
- The scar lies in the groin, usually within the hair-bearing area, and is inconspicuous.
- The pump is advanced into the scrotum through the same incision.
Key differences between the two approaches
- Reservoir placement: under direct vision in the infrapubic approach; by tactile technique in the penoscrotal.
- Scrotal access: direct in the penoscrotal approach, giving flexibility in pump positioning.
- Revision cases: the preference may change according to previous surgery and scar location.
- Scar: in both, the scar lies in an area not noticeable from the outside.
What matters is this: both approaches achieve similar satisfaction when applied to the right patient with the right technique. The choice depends on the patient's anatomy, previous operations, implant type and the surgeon's experience.
Which approach for which patient?
In patients with previous abdominal or groin surgery, where reservoir placement under direct vision is desirable, the infrapubic approach may come to the fore. In revision surgery or where special scrotal planning is needed, the penoscrotal approach may be preferred. A surgeon experienced in both techniques chooses according to the patient, not habit — and that is the right question to ask: which approach do you recommend in my case, and why?
Is it the incision or the surgeon that determines the outcome?
The incision site does not determine the result; what does is correct indication, meticulous infection prevention and surgical experience. The no-touch technique and antibiotic-coated implants can be used with either approach. What matters to the patient is not the name of the incision but the surgeon's depth of experience with it.
Assoc. Prof. Zülfü Sertkaya is one of Europe's leading high-volume penile implant surgeons, holding Boston Scientific AMS 700™ and Coloplast Titan® Center of Excellence credentials and operating with the no-touch technique, in which the implant is placed without skin contact. At his clinic in Istanbul, all assessments are carried out confidentially.