Managing Proximal Corporal Perforation During Penile Implant Surgery Using Re-dilatation Only: Demonstrating a Case of Infra-pubic Approach

M. Mahdi, A. Albakr, H. Slovacek, R. Wang

Inflatable Penile Prosthesis, Prosthesis infection, Laparoscopic removal

Proximal corporal perforation is a known complication during penile implant surgery and may predispose to cylinder migration and device failure. Various techniques have been described for its intra operative management, including formal corporal repair, windsock grafts, mesh plugs or patches, and cylinder fixation with sling sutures. This video demonstrates a simple alternative technique using only re-dilatation into a new proper tract without the need for corporal repair or fixation. A 69-year-old gentleman with erectile dysfunction, controlled diabetes, and prior bilateral hernia repair and robotic-assisted radical prostatectomy underwent penile implant surgery via an infrapubic approach. During the procedure, proximal corporal perforation occurred on the medial side of the right corpora. The complication was managed by re dilatation of the proximal corpora into a new tract starting from the corporotomy site away from the initial tract, following a more lateral direction up to the most proximal part of the corpora at the pubic bone. Sequential dilatation using up to size 13 Brooks dilator was done, allowing successful placement of the cylinders in the proper position. The patient recovered uneventfully and was able to use the device after 6 weeks, with no cylinder migration or complications at 6 months follow-up. We have used the demonstrated technique in many patients, with favorable outcome. This case highlights that re-dilatation into a new proper tract is an effective method for managing proximal corporal perforation during penile implant surgery. It is less time and cost consuming than the reported methods.

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