Addressing Early Inflatable Penile Prosthesis Cylinder Erosion: Is Salvage Procedure an Option?

M. Mahdi, M. A. M. Hammad, J. Lee, M. Mubarak, E. A. Chawareb, F. A. Yafi

Penile Fillers, Silicone, Split thickness skin grafting, Complications

Introduction:

Impending erosion of inflatable penile prosthesis (IPP) cylinders represents a challenging complication, often stemming from aggressive corporal dilation, oversized cylinders, improper insertion, or underlying patient comorbidities. Timely intervention is paramount to prevent complete device erosion, which typically necessitates full implant removal. While various techniques have been described for managing distal cylinder extrusion, including corporal repair with grafts, distal corporoplasty, proximal extracapsular tunneling, and distal corporal anchoring stitches, gross erosion traditionally mandates device components removal and delayed replacement.

Objectives:

We present a case of early unilateral IPP cylinder erosion where a salvage approach was attempted to save the implant.

Methods:

A 75-year-old male with a history of ulcerative colitis status post total colectomy and heavy smoking presented with early erosion of his left IPP cylinder. He had undergone three prior IPP procedures, with the most recent device removed in 2024 due to infection. A new AMS CX device was implanted in March 2025 into extensively fibrotic corpora. Two weeks post-operatively, the patient presented with early left cylinder erosion (image 1). Examination showed a thin layer of necrotic skin covering the implant. Given his complex surgical history and severe corporal scarring that would significantly complicate future interventions following full device removal, a salvage procedure was elected. This involved cylinder repositioning via extra capsular tunneling, a distal anchoring stitch, and corporal repair using a biological cap of human pericardium allograft (Tutoplast graft) (image 2).

Results:

The patient was discharged the following day with the device fully deflated, instructed to maintain it deflated for six weeks. His immediate postoperative course was uneventful. Unfortunately, three weeks post-procedure, he presented with re-erosion of the same cylinder. This ultimately necessitated removal of all device components and insertion of a single malleable implant in the contralateral corpora (image 3).

Conclusion:

Despite the unfavorable outcome in this specific case, salvaging early IPP cylinder erosion in the absence of infection may be considered as an alternative to complete device removal. This approach holds particular relevance for patients with multiple revision procedures, where further interventions would be exceptionally challenging.

None.

The authors have nothing to disclose