Salvage extracapsular re-implantation for penile prosthesis impending erosion

Aim of the study: Post-operative erosion of prosthesis components is an uncommon but devastating complication worth noting. Distal cylinder and scrotal pump erosion is usually related to infection but isolated erosion has been described in the literature. If the prosthetic material is not exposed to the exterior, impending erosion is present. Patients complain of pain over the end of the cylinder and worry that it will wear through the skin. and the prosthesis components may be evident with physical examination and can be confirmed if necessary through magnetic resonance imaging. Distal cylindrical erosion through the corpus cavernosum with extrusion affecting the urethra, glans, or corporeal shaft can be managed through multiple methods. Options include reseating the cylinders and using fibrotic tissue to support the containment of the cylinders, utilization of alloplastic materials such as Gortex polytetrafluoroethylene polypropylene mesh to create a “windsock” or utilization of prefabricated autologous fascial grafts. Herein we describe the technique of salvage extracapsular re- implantation for penile prosthesis impending erosion with the use of a distal corporoplasty by reseating the cylinder in a new cavity of spongy erectile tissue more dorsal or lateral to the extrusion site. Materials and methods: Circumcising incision is made and the distal corpora are exposed. A lateral longitudinal corporotomy of about 4 cm is made over the cylinder in the area of impending erosion and the inflatable cylinder is retracted proximally using a suture inserted through the hole in the end. At this point, the posterior wall of the fibrotic capsula containing the cylinder is incised transversely about 3–4 cm proximal to the glans. Subsequently The space is developed for a short distance by sharp dissection initially, then fully by inserting a metal dilator.In this manner a new cavity in the distal end of the corpus cavernosum is created. Using a Keith needle and introducer the inflatable cylinder is introduced into this new cavity. The corporotomy is closed using long-term absorbable suture. The cylinder is now secured in its proper location by 2 tough layers comprising the back wall of the original sheath and the corporotomy closure. Results: Routine post-operative care is followed. This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. Discussion: We propose that, on salvage for implant distal extrusion or impending erosion, the replacement implant can be inserted into the cavernous tissue surrounding the capsule, between the capsule and tunica albuginea (extracapsular reimplantation), rather than intra- capsular. Using this technique, the cylinder can be replaced in a more medial and secure position under the glans penis by creating a new cavity for the cylinder behind the back wall of the fibrotic sheath Moreover, this may reduce contact between the replacement implant