Complex Management of Cylinder Coating Adhesion in Infrapubic Penile Prosthesis Revision Surgery

Pozzi E, Capogrosso, P, Schifano, N, Baldini, S, Montorsi, F, Dehò, F, Antonini, G

Penile prosthesis revision, mechanical failure, infrapubic approach, surgical complications

The video demonstrates a challenging third-time revision case of a three-piece inflatable penile prosthesis in a 60-year-old male with a history of two previous inflatable penile prosthesis implantations (IPP) – the first using a peno-scrotal approach and the second using an infra-pubic approach. The current revision surgery was primarily indicated due to the patient's significant dissatisfaction regarding both erection strength and girth, with some uncertainty about possible device functionality. The surgical approach highlights a rare but significant complication: severe adhesion of cylinder coating to the tunica albuginea, likely due to scarring of the previous surgeries. Using an infrapubic surgical access, the procedure showcases the step-by-step management of firmly adherent prosthetic material, with particular focus on the left corporal body where a challenging situation arose as the cylinder coating separated during extraction, leaving its distal portion firmly adhered to the tunica albuginea at the sub-glandular level. To address this retained material, we performed a lateral incision at the sub-glandular level, which provided direct visualization and allowed for complete extraction of the adherent cylinder coating. Following successful removal, reimplantation of a new three-piece device was performed through the same infrapubic incision, with reservoir placement in the space of Retzius. The video highlights the critical decision points, surgical steps, and technical challenges essential for managing such complicated IPP revisions [1]. Lastly, careful attention to hematoma’s prevention is demonstrated via the placement of two scrotal drains [2].

Flukka Pharma for funding the production

None. 

[1] El-Achkar A, Khalafalla K, Nguyen TT, Wang R. A systematic review comparing different approaches for inflatable penile prosthesis revision: partial-component exchange, complete-component exchange, or reservoir drain and retain. Sex Med Rev 2024;12:519–27. https://doi.org/10.1093/sxmrev/qeae035.

[2] Braun AE, Swerdloff D, Sudhakar A, Patel RD, Gross MS, Simhan J. Defining the incidence and management of postoperative scrotal hematoma after primary and complex three-piece inflatable penile prosthesis surgery. Int J Impot Res 2025;37:82–6. https://doi.org/10.1038/s41443-023-00697-2.