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Cavernotomes

Cavernotomes are specialized cutting dilators used to create a channel through dense corporal fibrosis during penile-prosthesis implantation when blunt dilation is inadequate. They act within the corpus cavernosum, not the urethra, and are grouped here with other cutting-dilation instruments. In a retrospective 42-patient multicenter referral cohort, cavernotomes were used alone in 25 cases (59.5%) and with limited sharp excision in one further case (2.4%); these figures describe the selected cohort, not routine implant practice.[4]

When They Are Needed​

Cavernotomes may be considered after an initial corporal tract has been established but dense scar prevents adequate blunt dilation.[11] Severe fibrosis is particularly encountered after:

  • Prior prosthesis explant. In a 42-patient referral cohort with corporal fibrosis, prior explant for infection was recorded in 40.5% and for erosion in 16.7%.[4]
  • Ischemic priapism (14 of 42, 33%, in one referral cohort; 5 of the 14 had distal shunts)[4]
  • Other causes. Diabetes, Peyronie disease, intracavernosal injections and trauma have been described.[11] In a 16-centre implant series, corporal scarring and prior radiation were each associated with intraoperative corporal complications (OR 2.77 and 2.25).[6]

The full intraoperative escalation ladder (VED prehab, Hegar dilation, cavernotomes, counter incisions, corporeal excavation, then grafting) is laid out on the penile-prosthesis revision-scenarios page.

Designs​

Carrion-Rossello cavernotomes​

The Carrion-Rossello set uses a backward-cutting rasp: the instrument is advanced and then withdrawn repeatedly so its rasp files fibrotic tissue. A contemporary review describes sequential 8–12 mm sizes and emphasizes keeping the smooth surface toward the septum and urethra.[11] This is a distinct design from the forward-cutting Mooreville instruments; neither name should be used as a generic specification for every cavernotome.

Mooreville cavernotomes (Uramix)​

The original Mooreville cavernotome was reported in 1999 as a five-instrument, 6–13 mm set making controlled 1 mm cuts with oscillating advancement and rotational shaving.[1] The current manufacturer page describes a different Mooreville II double-bladed configuration.[10]

Current Mooreville II featureManufacturer-listed specification
Main setSix instruments: 6, 7, 8, 9, 10 and 11 mm
Extra-large set12, 13 and 14 mm
Working elementTwo parallel 5 cm blades, extending to within 0.5 cm of the rounded tip; blade height remains within the dilator circumference
Instrument length23.5 cm, with centimeter markings
HandlesFixed- and removable-handle versions; an additional handle is listed for torque and blade orientation
MovementLongitudinal cutting or rotational shaving; instruments are used in succession

These are manufacturer specifications for the currently marketed product, not comparative clinical claims. The product page says the instrument and handle are autoclavable. Confirm reprocessing parameters in the current instructions for use.[10]

Technique​

  1. Expose and open the corpus sufficiently for instrument entry. The Mooreville II manufacturer product page describes scalpel access extended proximally and distally; the original clinical series used a high transverse scrotal approach.[1][10]
  2. Establish an initial tract. Reviews describe blunt dilation first and note that a cavernotome requires a channel in which to work.[5][11]
  3. Start small and progress sequentially. Match the sequence to the specific system and the intended cylinder; millimeters, not French, are used for these instruments.[1][10]
  4. Orient the working element laterally at entry. The Mooreville II manufacturer product page says so, and one operative video describes aiming the cutting edge laterally, away from the urethra. Stay aware of the urethra, septum and tunica; orientation differs between backward- and forward-cutting systems.[5][10][11]
  5. Advance with controlled motion. The Mooreville design uses oscillating longitudinal movement and, when needed, rotational shaving rather than forceful thrusting.[1][10] Wilson and colleagues advise extending the corporotomy and adding stay sutures, or making a second corporotomy under direct vision, when a tract cannot be developed without force. They also describe periodic irrigation of the corporal space to check for occult urethral injury before cylinder placement.[13]

Where no developable plane exists, the Wilson backward-cutting scissors are used first to carve the initial channel so a cavernotome can be seated.

Outcomes​

In the original Mooreville series (n = 16), bilateral three-piece device implantation was completed in all patients; 14 received downsized cylinders, no urethral laceration caused termination, and no graft was needed to close the corporotomy. These are uncontrolled single-series findings with follow-up only to publication.[1]

In the Krughoff multicenter retrospective cohort (n = 42), 25 patients had cavernotome dilation, 15 had standard sequential dilation, and one had limited sharp excision plus cavernotomes; one patient had a major complication (1/42, 2.4%) and underwent explantation for infection and distal erosion. The study evaluated an overall fibrosis cohort, not a randomized comparison of instruments.[4]

Complications and Limitations​

The defining limitation is cutting within the corpus without direct visualization of the entire instrument path. In the original 16-patient series:[1]

  • Proximal crural perforation. 5/16 (31%), managed by suturing the rear-tip extender to the tunica with nonabsorbable suture[1]
  • Postoperative distal tunical perforation. 4/16 (25%), repaired with native tissue[1]
  • No urethral laceration terminated a case, but this small series does not eliminate urethral-injury risk[1]

Direct-Vision Adjuncts and Alternatives​

Several techniques address the "out of sight" problem or substitute for cavernotomes entirely:

  • Ultrasound-guided cavernotomy (Shaeer 2007). Real-time sonography guided the instrument in the mid-corpus, away from the tunica and urethra; in five cases, operative time was 50–60 min and no complications were reported.[7]
  • Corporoscopic excavation (Shaeer's technique). Optical urethrotomy plus transurethral resection instruments perform force-free, directly visualized excavation of scar through an approximately 1.5 cm tunical incision.[8]
  • Corporeal excavation (Montague-Angermeier). Extended ventral corporotomies via an inverted-T penoscrotal incision develop a plane between scar and inner tunica for core removal of nearly all fibrotic tissue; successful in all 9 patients in the original series without grafting.[9]
  • Downsized or narrow-base cylinders. Narrow-diameter devices may allow implantation when full dilation is unsafe or not achievable.[4][11]

Place in Practice​

Evidence is dominated by technical reports and retrospective series. Choice among blunt dilation, a named cavernotome, narrow cylinders, excavation, additional corporotomies or graft reconstruction depends on the fibrosis pattern, equipment and surgeon experience.[2][3][11] Current EAU guidance lists Carrion-Rossello, Uramix and Mooreville cavernotomes among options for severe post-priapism corporal fibrosis; it does not endorse one design as superior.[12] Complex cases are generally directed to experienced, high-volume prosthetic practices.[11]

See also: Wilson Backward-Cutting Scissors, Hegar Dilators, Otis Urethrotome, Penile prosthesis revision scenarios, corporal fibrosis.

Videos​

Macroporous Polypropylene Mesh Augmentation for Tunica Defects in IPP Revision
VJSM (Video Journal of Sexual Medicine, ISSM) · L. Karapanos, ~8 min. Operative salvage for an accidental tunical perforation during dilation of a severely fibrotic corpus in inflatable penile prosthesis revision — the exact complication this instrument can cause. Hosted on the ISSM Vimeo channel; embed restricted to the publisher's domain, so opens externally.
vjsm.info · Video Journal of Sexual Medicine

References​

1. Mooreville M, Adrian S, Delk JR, Wilson SK. "Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome." J Urol. 1999;162(6):2054–7. doi:10.1016/S0022-5347(05)68099-8

2. Martínez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. "Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review." J Sex Med. 2011;8(7):1880–9. doi:10.1111/j.1743-6109.2011.02281.x

3. Trost L, Patil M, Kramer A. "Critical appraisal and review of management strategies for severe fibrosis during penile implant surgery." J Sex Med. 2015;12(Suppl 7):439–47. doi:10.1111/jsm.12985

4. Krughoff K, Bearelly P, Apoj M, et al. "Multicenter surgical outcomes of penile prosthesis placement in patients with corporal fibrosis and review of the literature." Int J Impot Res. 2022;34(1):86–92. doi:10.1038/s41443-020-00373-9

5. Clavijo RI, Sávio LF, Prakash NS, et al. "Three-piece penile prosthesis implantation in refractory ischemic priapism — tips and tricks." Urology. 2017;106:233–235. doi:10.1016/j.urology.2017.04.032

6. Chang C, Barham DW, Dalimov Z, et al. "New findings regarding predictors of poor corporal integrity in penile implant recipients: a multicenter international investigation." BJU Int. 2025;135(3):528–534. doi:10.1111/bju.16607

7. Shaeer O. "Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation." J Sex Med. 2007;4(3):809–814. doi:10.1111/j.1743-6109.2007.00467.x

8. Shaeer O, Shaeer A. "Corporoscopic excavation of the fibrosed corpora cavernosa for penile prosthesis implantation: optical corporotomy and trans-corporeal resection, Shaeer's technique." J Sex Med. 2007;4(1):218–225. doi:10.1111/j.1743-6109.2006.00348.x

9. Montague DK, Angermeier KW. "Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis." Urology. 2006;67(5):1072–5. doi:10.1016/j.urology.2005.11.001

10. Uramix. The Mooreville II — Double-Bladed Advanced Cavernotome. Current manufacturer product page. Accessed September 21, 2026.

11. Fernandez Crespo RE, Stroie F, Taylor L, et al. "Penile fibrosis—still scarring urologists today: a narrative review." Transl Androl Urol. 2024;13(1):127–138. doi:10.21037/tau-23-206

12. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Priapism. Limited Update March 2026, section 10.1.3.b.3, surgery for non-acute sequelae after ischaemic priapism.

13. Wilson SK, Simhan J, Gross MS. "Cylinder insertion into scarred corporal bodies: prosthetic urology's most difficult challenge: some suggestions for making the surgery easier." Int J Impot Res. 2020;32(5):483–494. doi:10.1038/s41443-020-0282-0