Inflatable Penile Prosthesis in a Patient with Prior Explanation and Severe Fibrosis

V. Lima, V. Santos, M. Zangari, L. Wolff, T. Mierzwa

Introduction:

Erectile dysfunction (ED) following radical prostatectomy remains a significant challenge,

often requiring penile prosthesis implantation for adequate management. We present a complex case of prosthesis re-implantation in a 77-year-old male with severe corporal fibrosis and prior prosthesis explantation due to infection.

Case Presentation:

The patient, with a history of cardiac arrhythmia and hypothyroidism, initially underwent penile prosthesis implantation in 2022, which was subsequently removed due to postoperative infection. No reimplantation or further treatment had been performed until the current intervention. On examination, multiple fibrotic areas were identified in the

penile shaft. A penoscrotal approach was used, with meticulous dissection revealing extensive fibrosis. Serial dilations were performed, with fibrotic areas managed using both the Rossello cavernotome and manual disruption. Care was taken to preserve urethral integrity throughout the procedure.

Bilateral distal dilation was achieved with Hegar dilators, proxima perfuration was observed in the left corpora caveronsa. Following exhaustive irrigation with antibiotic solution, sling technique was performed to assure correct position of the left cilinder and distal implantation was performed using a guidewire technique with the furlow. A Prolene suture on the left for distal fixation of the prosthesis in the glans. Both cylinders were

properly positioned and fixated with axial stability. The reservoir was introduced into the retropubic space using a nasal speculum, anchored with a retention ring. The system was assembled with airtight technique to avoid air entry. The pump was placed on the scrotum, secured via layered closure with Vicryl sutures. A drain was placed to prevent hematoma formation The surgical sites were dressed with compressive bandages to reduce postoperative complications.

Conclusion:

Penile prosthesis reimplantation in the setting of extensive corporal fibrosis requires careful planning, surgical precision, and adaptation of techniques to overcome anatomical challenges. The combined use of Rossello cavernotome for the intense fibrosis, repair techniques for proximal perfuration, along with meticulous dilation and implantation strategies, allowed for successful prosthesis placement and functional restoration.