(196) Reconstruction of Complex Midline Septal Corporal Defect in a Distal Crossover Penile Implant Cylinder: A Step-by-step Demonstration of Surgical Technique

Abstract

Abstract Introduction Inflatable penile prosthesis (IPP) placement is a common and effective treatment for erectile dysfunction. Around 20,000 procedures are performed annually. Complications can arise after the procedure, with non-infectious complications occurring in approximately 4% of cases. One rare non-infectious complication is complete cylinder crossover, which can happen due to variable windows in the corporal septum. Objective This case report presents a complex distal septal defect caused by distal cylinder crossover and its repair using Tutoplast graft. Methods The patient, a 59-year-old African American male, had a history of prostate cancer and underwent robotic-assisted laparoscopic prostatectomy in 2018. He received an IPP in September 2020. In 2022, the patient experienced painful leftward penile curvature during erections and incomplete deflation of the penile prosthesis. A physical examination revealed crossover of the right prosthesis cylinder to the left. After a thorough discussion of the risks and benefits, the patient opted for surgical revision and reconstruction of the penile prosthesis. The procedure involved a right corporotomy, septal corporal reconstruction using a 5 × 2 cm Tutoplast graft, and redirection of the uninfected, functioning cylinder into the neocorporal space. Results The surgery was successfully completed without any complications, and the IPP functioned well at the end of the procedure. During the 6-week clinic follow-up, the patient reported proper cycling of the device, excellent erectile function, the ability to orgasm, and minimal pain. Conclusions In conclusion, our case demonstrates that Tutoplast graft, along with appropriate seating and redirection of the displaced cylinder without replacing the functional hardware, is a viable surgical approach for IPP revision, even in complex cases involving septal defects. Disclosure No.