306 Penile Wobble Effect: Proximal Corporal Dilatation as a Cause of Penile Prosthesis Failure

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Penile structural defects may contribute toward penile prosthesis (PP) surgical complications or suboptimal outcomes such as distortion, angulation, extrusion, and crossover. We describe an observation of proximal corporal dilatation that affects PP device function. A retrospective analysis of Johns Hopkins institutional database of all patients who had PP surgery, from January 2013 to March 2017, was done. All cases of penile structural defects requiring surgical correction were identified. Data retrieved included demographics, causes of erectile dysfunction, number and causes of previous revisions, and surgical outcomes. We identified nine patients with proximal corporal dilatations (proximally from the penoscrotal junction), who required surgical revisions. Seven patients reported intact cycling PP devices, although they were unsteady and not usable; 2 reported devices that were not operational. Mean age at revision was 64.2+/-7.7 years (IQR 60-67). Mean elapsed time having PP devices was 15.1+/-14.1 years (IQR 4.5-24.5). Mean number of previous revisions was 2.4+/-3.3 times, and maximum revision number was 11 times. Causes of revisions commonly included replacement of intact but unstable PP devices (77.8%). The etiologies of erectile dysfunction were veno-occlusive disease in four patients (44.4%), post-radical prostatectomy in three patients (33.3%), pelvic trauma in one patient (11.1%), and vasculogenic in one patient (11.1%). Intraoperatively, eight patients (88.9%) had unilateral and one patient (11.1%) had bilateral corporal dilatations. Seven patients had intact cycling PP (77.8%), one had coexistent proximal cylinder rupture (11.1%), and one had mechanical failure (11.1%). All underwent reduction corporoplasty with PP removal and replacement. No perioperative adverse events occurred. All patients reported PP stability and satisfaction after revision with 7.5 months’ median follow-up time.