Wilson Backward-Cutting Scissors
Heavy backward-cutting scissors with outside blade edges that cut when the blades are spread in dense tissue, as well as conventional cutting on closure. Wilson and colleagues describe the instrument, also called the Freeman-Kaye or Gourney pattern, as one option to create a short starter space in severely fibrotic corpora before a cavernotome can engage the scar. It does not replace controlled exposure.[1][2]
Design
- Outer blade edges sharpened. In Wilson's original description, the outside of each blade is sharp, so the blades cut scar on opening as well as on closure.[2]
- Heavy construction. Built to push and spread against dense scar without deflecting, unlike fine dissecting scissors.
- Model and material. Wilson's 2020 operative paper describes two sizes of heavy-duty titanium scissors; the current Uramix store lists four Wilson-Mooreville size options. Check geometry, material and reprocessing instructions against the model supplied.[2][3]
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.
When a standard Hegar dilator cannot traverse a densely scarred corpus, Wilson describes a 1–2 cm starter space made with backward-cutting scissors or a #15-scalpel cruciate incision before a cutting cavernotome engages the scar. The choice and subsequent channel size depend on anatomy, device and exposure; forceful blind advancement is discouraged.[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) | Outside blade edges | Cuts dense scar as blades open to establish a short starter space |
This dual action distinguishes the instrument from the usual blunt spreading with a Metzenbaum. Metzenbaum scissors can still have a role during exposed corporal scar dissection; they are not categorically useless in all fibrotic cases.[1]
Technique
- Expose the corporotomy and assess the fibrotic corporal lumen and adjacent urethra and tunica before selecting a cutting instrument.
- Create a short starter space by inserting the appropriate closed scissors into the identified scar and spreading in controlled increments; Wilson describes about 1–2 cm before a cavernotome can engage. A cruciate #15-blade incision is an alternative in his technique.[2]
- Keep the instrument within the intended corporal tract, away from both the urethra and tunica. Avoid blind distal advancement; extend or add a corporotomy for direct visualization when necessary.[1][2]
- Hand off to a cavernotome if safe space exists, then size the tract to the actual insertion tool and chosen cylinder. Wilson's 2020 examples describe 9 mm for the Furlow tool and 9–11 mm proximally depending on cylinder model; these are source-specific examples, not universal current AMS/Coloplast IFU limits.[2]
- Stop rather than force an instrument that cannot safely create a tract; extend the corporotomy or consider directly visualized excavation or grafting as appropriate. Wilson also describes irrigating to check for an unrecognized urethral injury before completing implantation.[2]
Limitations and Safety
- Specialized role. Described for a scarred corporal tract, not routine soft-tissue dissection; use Metzenbaum or Mayo variants where those better fit the exposed layer.
- Perforation risk. Sharp outside edges can injure either the urethra or tunica when the tract or depth is lost. Avoid forcing, keep exposure and check for injury.[1][2]
- Availability. Plan ahead for known or anticipated fibrosis, because standard trays may not include these scissors.
Naming
Wilson's operative account calls the instrument Freeman Kaye or Gourney and describes its adaptation for scarred-corpora cylinder insertion.[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; full text.
3. Uramix. Wilson-Mooreville Backward Cutting Scissors, SKU 6611. Product listing reports four size options; verify the supplied model's current instructions.