Wilson Backward-Cutting Scissors
Heavy scissors whose blades are sharpened on the outside edges as well as the cutting edges, so they cut both in the conventional closing motion and when spread open inside scar. Also called Freeman-Kaye or Gourney scissors (supplied for prosthetic use by Uramix, Lansdowne, PA), they are a niche but valuable tool for penile prosthesis implantation into densely fibrotic corpora cavernosa — used to carve the initial channel within scar so that cavernotomes and cylinders can subsequently be passed.[1][2]
Design
- Outer blade edges sharpened — the defining feature. A standard scissor cuts only between the closing blades; on the Wilson backward-cutting scissor the convex (outside) surface of each blade is also a cutting edge, so spreading the blades apart inside fibrotic tissue resects it outward.[1]
- Heavy, robust construction — built to push and spread against dense scar without deflecting, unlike fine dissecting scissors.
- Blunt-to-moderate tips — advanced into the corpus from the corporotomy.
- Ring handles with box-lock pivot; surgical stainless steel, autoclavable.
Reconstructive-Urology Use
Effectively a single-indication instrument in reconstructive urology: establishing access in the scarred corpus cavernosum during inflatable or malleable penile prosthesis surgery. The corpora most often requiring it are those scarred by prior device explantation for infection, ischemic priapism, prior shunt surgery, or trauma — see the corporal fibrosis section of the penile-prosthesis revision-scenarios page for the full management ladder.
The scissors sit early in the stepwise escalation for the densely fibrotic corpus: after standard Hegar dilation fails, they create the initial space within the obliterated corpus so that the cavernotomes can then be seated and the channel enlarged to a cylinder-accepting diameter.[1][2]
How It Cuts — Two Modes
| Motion | Cutting surface | Use in scar |
|---|---|---|
| Closing (conventional) | Inner opposed edges | Divides scar bands directly under the tips |
| Spreading (backward cutting) | Outer convex edges | Resects scar outward as the blades open — enlarges the channel without re-inserting and re-closing |
This dual action is what distinguishes the instrument from a Metzenbaum, where spreading bluntly separates a tissue plane but does not cut — useless in a corpus with no preserved plane to develop.
Technique
- Open the corporotomy and confirm there is no developable plane (dense intracorporal fibrosis).
- Insert closed, then spread to cut the surrounding scar with the outer blade edges; advance in increments, carving a midline channel proximally and distally.
- Aim the cutting force laterally, away from the urethra — the cardinal safety rule for every cutting maneuver in the fibrotic corpus.
- Hand off to a cavernotome (Rossello-Carrión backward-cutting rasp; Mooreville 1 mm rotating blade) once a starter channel exists, then dilate to the diameter the chosen cylinder needs — 10 mm for a narrow-base device (AMS 700 CXR, Coloplast Titan Narrow Base), 12 mm for a standard cylinder.
- Escalate to extended corporotomy / corporeal excavation or grafting if the channel cannot be safely established — these are the next rungs of the fibrosis ladder.
Limitations and Safety
- Single-purpose — no role outside the scarred corpus; for all routine dissection use a Metzenbaum or Mayo.
- Perforation risk — sharp outer edges that resect on spreading also resect tunica and can injure the urethra if directed medially; the cutting vector must stay lateral.
- Not stocked on a standard tray — a deliberately requested instrument for known or anticipated fibrosis cases at high-volume implant centers, alongside the cavernotome set and narrow-base cylinders.
Naming
The instrument is a re-purposed general-surgical scissor (the Freeman-Kaye / Gourney pattern) popularized for scarred-corpora prosthetic surgery and commonly attributed to Steven K. Wilson's descriptions of cylinder insertion into fibrotic corpora.[2]
See also: Metzenbaum Scissors, Mayo Scissors, Hegar Dilators, Penile prosthesis revision scenarios — corporal fibrosis.
References
1. Fernandez Crespo RE, Stroie F, Taylor L, Pignanelli M, Parker J, Carrion R. "Penile fibrosis—still scarring urologists today: a narrative review." Transl Androl Urol. 2024;13(1):127–138. doi:10.21037/tau-23-206
2. 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