Graft-on-Graft Reconstruction With Proximal Extracapsular Tunneling for the repair of Large Aneurysmal Defect After Penile Prosthesis Surgery in Peyronie’s Disease

K. Khalafalla, J. Clavell Hernández

Penile Prosthesis, Peyronie's Disease, Extracapsular tunnelling, Graft on Graft Reconstruction, Cylinder Aneurysm

Corporal “aneurysm” with cylinder migration can develop after penile prosthesis implantation (PPI) performed with plaque incision and grafting, yet operative guidance is limited. We describe a revision technique that corrected a large lateral aneurysmal defect at a prior pericardial graft edge.

Intraoperatively, a 2-cm proximal length discrepancy caused by pseudocapsule narrowing was equalized using proximal extracapsular tunneling (PET), restoring symmetric 20-cm corporal measurements. Distally, we reinforced the weakened wall by folding the existing graft to create a double layer, then overlaying a new double-layer Tutoplast® pericardial patch, secured with absorbable contouring sutures and targeted non-absorbable anchors at graft-to-graft interfaces. The replacement device seated stably with immediate correction and no complications.

Key points: distinguish undersizing/malposition from true aneurysm preoperatively; use PET to address proximal shortening; consider graft-on-graft reinforcement to reconstitute circumferential strength and reduce recurrence risk and optimize functional outcomes.

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