Armored penile implant: an approach to multiple tunica albuginea defects

Tulio Cavalcanti, M, Gutierrez Claure , L. Lattanzi Nunes, C, de Padua Rodrigues D, Mauad Lacerda, D, Monteiro, L

Penile Prosthesis; Polypropylenes; Male Genital Diseases.

Penile prosthesis (PP) implantation surgery presents unique challenges, particularly in complex cases requiring penile reconstruction. The current literature highlights various surgical techniques; however, there remains limited evidence regarding the feasibility and outcomes of penile reconstructive surgery utilizing inflatable penile prosthesis (IPP) in combination with polypropylene mesh. This video aims to demonstrate a technique for IPP implantation, involving the complete coverage of the prosthetic cylinders with polypropylene mesh, referred to as an armored implant.

The patient has complete fibrosis of the corpus cavernosum due to intracavernous injections of veterinary medications. Our team performed a total of four surgeries on this patient. Initially, the patient underwent implantation of an inflatable penile prosthesis (IPP). Three months after the procedure, a salvage surgery following Mulcahy's protocol with malleable penile prosthesis (MPP) was carried out due to infection. Subsequently, the patient requested an upgrade surgery to re-implant a new IPP and surgery was performed. Four months later, was observed a proximal aneurysm of both cylinders, accompanied by significant defects in the bilateral proximal tunica albuginea, and an impending erosion of distal right cylinders.

The surgery to the "armored" implant, used a polypropylene mesh fashioned around the implant, creating a "shielded implant," due to multiple areas of failure in the tunica albuginea caused by previous surgical manipulations and infection. By applying the polypropylene mesh along the length of the cylinder, we successfully reconstructed the distal area and prevented the formation of new aneurysm lesions. The procedure was completed without complications. The patient is currently under follow-up in our clinic and is showing satisfactory progress. This case suggests that the use of an "armored" implant is both safe and feasible, while also reducing exposure time during surgery

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