Impending Cylinder Erosion

Ralph, D.

erosion, extrusion, penile, implant, erectile, dysfunction

Impending erosion is a recognised complication of penile implant surgery. It requires recognition and prompt surgical attention, before the cylinder breaches the skin and requires complete prosthesis explantation.

Various methods have been described to manage impending erosion, including the windsock graft, which was applied to the tip of the implant. The distal corporoplasty technique allows the correction of impending distal erosion without the need of a graft and seems to provide durable outcomes.

This video demonstrates two cases of distal corporoplasty and briefly illustrates the alternative windsock technique. The first case is related to a malleable prosthesis and the second to a three piece inflatable device. In both situations, at the time of the original implantation, a distal corporotomy was performed in order to address a challenging dilatation due to corporal fibrosis.

Revision surgery has been carried out though a ventral subcoronal incision with partial degloving of the penis. The cylinder tip was exposed through a longitudinal incision of the tunica albuginea and a new position was created deep and medial to the dorsal wall of the capsule. The previous capsule is closed and the cylinder successfully repositioned into the newly formed channel.

With this video, we hope to be able to clearly demonstrate these surgical options and thus enable better management of this prosthetic surgical complication.

Henry GD, Laborde E. A review of surgical techniques for impending distal erosion and intraoperative penile implant complications: part 2 of a three-part review series on penile prosthetic surgery. Journal of Sexual Medicine. 2012. 9(3):927-36 Smith CP, Kraus SR, Boone TB. Management of impending penile prosthesis erosion with a polytetrafluoroethylene distal wind sock graft. Journal of Urology. 1998;160(6): 2037-40 Carson CC, Noh CH.  Distal penile prosthesis extrusion: treatment with distal corporoplasty or Gortex windsock reinforcement. International Journal of Impotence Research. 2002. 14, 81–84