Penile Disassembly and Reconstructive Surgery in Severe Corporal Fibrosis

M. T. Cavalcanti, R. B. Moreira, F. Sandoval, L. G. Morato de Toledo

Penile prosthesis; corporal fibrosis; reconstructive surgery; malleable implant; priapism; penile disassembl

This video presents a challenging case of penile reconstructive surgery in a 27 year-old male with a history of recurrent ischemic priapism secondary to sickle cell anemia. After multiple failed interventions and the development of a corporal abscess, the patient evolved with severe erectile dysfunction and total fibrosis of the corpora cavernosa.

We demonstrate a complete penile disassembly technique with elevation of the neurovascular bundle and urethra, followed by reconstruction using a malleable penile prosthesis (MPP) and bovine pericardium graft. Key technical steps such as subcoronal incision, corporal exposure, fibrotic tissue management, and implant accommodation are highlighted.

The video is valuable for urologists and reconstructive surgeons, particularly in cases were fibrosis compromises prosthesis implantation. It offers practical guidance for managing complex anatomy and achieving functional and aesthetic outcomes.

1. Levine LA, Dimitriou RJ. Venous leak: pathophysiology and treatment. Urol Clin North Am. 2001;28:335-343
2. Mulhall JP, et al. Management of Priapism. J Sex Med. 2016;13:73-90
3. Ralph DJ, Garaffa G. Penile prosthesis implantation in patients with corporal fibrosis. Asian J Androl. 2013;15:261–265
4. Burnett AL. Surgical management of ischemic priapism. J Urol. 2003;170:1314–1317
5. Hsu GL, et al. Anatomical comparison of human and monkey penises. J Androl. 2004;25:426–431