Unusual Fracture in a Malleable Penile Prosthesis

P. A. Soffner-Cardoso, R. Jost, D. P. C. Mesias, R. V. Juliano, S. Glina, L. Seligra-Lopes

malleable penile prosthesis, extender fracture, revision surgery

Malleable penile prosthesis implantation is a well-established treatment for refractory erectile dysfunction, with high long-term success rates. Nevertheless, mechanical failures and technical errors may compromise functional outcomes. Distal extender fracture is a rare complication, typically associated with improper implantation. This video presents a 69-year-old man with hypertension and prior benign prostatic hyperplasia, who underwent penile prosthesis placement in 2008 at another institution. He presented with penile deformity, loss of rigidity, and the perception of internal fracture. Physical examination demonstrated marked axial instability, while radiography excluded shaft fracture but suggested prosthetic displacement, leading to clinical suspicion of crural perforation or mechanical failure. Intraoperatively, an inverted malleable prosthesis with a fractured distal extender was identified. Fibrosis and encapsulation precluded removal through a proximal approach. A penile inversion maneuver with new distal exposure was performed, requiring two corporotomies per corpus cavernosum (proximal and distal) to extract the fragments and allow sequential dilation. A new implant was placed with symmetric alignment. The video documents the entire process, from clinical evaluation to surgical reconstruction. This case highlights a preventable technical error with significant functional consequences. Distal extender fracture combined with prosthesis inversion is challenging to diagnose solely with imaging. Surgical management required expanded corporal exposure, underscoring the complexity of revision prosthetic surgery. Mastery of maneuvers such as penile inversion and multiple corporotomies, combined with thorough anatomical knowledge, are critical for success. Continuous training and adherence to technical standards are essential to prevent avoidable complications and to provide safe, effective treatment in prosthetic urology.

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