Course Materials

IPP Surgical Preference Card

Dr. Gheiler’s preference card for 3-piece inflatable penile prosthesis cases — the set-up his OR teams work from, consolidated into one reference.

This card describes Dr. Gheiler’s practice, shared for professional education — it is not a recommended protocol or clinical guidance. Antimicrobial selection in particular varies with the procedure, culture results, local resistance patterns, and patient-specific risks (see the AUA statement on urologic procedures and antimicrobial prophylaxis). Individual clinical judgment, contraindications, patient factors, and each facility’s own item stock always apply.

Content reviewed by Dr. Gheiler: August 28, 2026.

Surgeon: Edward Gheiler, MD, FACS

Procedure: Insertion of 3-piece inflatable penile prosthesis (IPP)

Gowns & Gloves

  • Ortho size 8 gloves ×3 pairs — non-latex (Biogel).
  • Regular surgical gown, X-large — not the gown from inside the pack.
  • All scrubbed personnel double-glove with frequent glove changes; always change gloves before handling the prosthesis.

Position

  • Supine with the hips at the table break; table flexed with slight Trendelenburg.
  • Both arms extended.
  • Patient in a paper gown, covered with a medium drape — not a blanket.

Skin Prep

  • 1) Shave (hips to thighs)  2) Hibiclens  3) ChloraPrep.
  • Dry off the Hibiclens completely before applying the ChloraPrep.
  • Pull the foreskin back and scrub diligently — if this cannot be done, notify the surgeon before proceeding.

Packs, Drapes & Basins

  • Pediatric laparotomy T-drape.
  • Large sheets ×2.
  • Towels & basin set, Mayo cover.
  • Large Ioban incise drape.

Instruments & Trays

  • Penile implant tray — confirm it has Hegar dilators, a Furlow, and a 5″ nasal speculum.
  • Minor (appendix) tray.
  • Lone Star retractor ring with elastic stays.
  • Medium/large Kelly clamps ×2 (clamp to the Lone Star) and sponge-stick forceps ×2, sterile, as extras.

Supplies & Specials

  • Light handles, marking pen.
  • Extra Asepto syringe; extra Yankauer suction tip.
  • 60 cc syringe ×2; 30 cc syringe with 20G needle (for the local block).
  • Sterile Kerlix roll; 2″ Coban.

Sutures

  • 2-0 Monocryl UR-6 ×4.
  • 3-0 Monocryl SH ×1.
  • 4-0 Monocryl SH ×1.
  • 3-0 Vicryl SH ×1.
  • Silk — drain stitch.

Drain & Dressings

  • Round closed-suction JP drain, 19 Fr, with bulb reservoir — attach to suction, do not leave the drain open.
  • Opsite 2×2 over the drain.
  • Incision: Dermabond only — no dressing on the incision.
  • 4×4s, fluffs, Kerlix, 4″ Coban, scrotal support.

Medications

  • Antibiotic irrigation: Rifampin 600 mg + Gentamicin 80 mg in 0.9% NaCl; if Rifampin is not available, Vancomycin 1 g + Gentamicin 80 mg.
  • Local block: Naropin (ropivacaine) 0.5%, 150 mg/30 mL, in the 30 cc syringe with the 20G needle. Xylocaine with epinephrine is no longer used.
  • Pre-op IV: Vancomycin 1 g and Gentamicin 5 mg/kg — fully infused before the patient goes to the OR suite.

Implant & Catheter

  • Rep brings 3–4 packs: accessory kit, pump, cylinders, and reservoir — confirm sizes with the rep.
  • Implant boxes (assembly & reservoir) are not opened until the patient is fully draped.
  • No indwelling catheter during the case; Foley 16 Fr on the field at the end of the case.

Removal / Infected Revision Set-up

  • Two set-ups (small table or extra Mayo stand) when the removal is infected.
  • Gentamicin 80 mg, Betadine solution, hydrogen peroxide.
  • Culture tubes.

Zero-Infection IPP Protocol

  • All preoperative antibiotics completed before surgical incision — given before the patient is taken to the OR suite, to allow proper tissue levels.
  • Inside the OR, replace blankets and sheets with a sterile half sheet before entering the suite, to minimize contamination of the back table.
  • Under no circumstances are patient gowns or sheets used as elevated barriers between anesthesia and the surgical field.
  • Ask the patient to void in pre-op — no urethral irrigation and no straight catheterization before the procedure.
  • Thorough two-stage skin prep (Hibiclens, then ChloraPrep) with the foreskin pulled back and scrubbed.
  • All scrubbed personnel double-glove and change gloves frequently — always before handling the prosthesis.
  • Limit OR traffic once the room is open.
  • Implant boxes stay closed until the patient is fully draped.
  • Make sure the drain is attached to suction — never left open.

Consolidated from the preference cards Dr. Gheiler’s surgical teams maintain at his facilities. Manufacturer reference numbers are intentionally omitted — item codes vary by facility; build your own card against your OR’s stock.

See this set-up working in the OR

Training programs should be coordinated through your local Boston Scientific implant representative.

Coordinate Training