CAVERNOSCOPY AS AN AID IN THE REMOVAL OF A PENILE PROSTHESIS

Abstract

We describe a novel technique for retrieving a rear tip extender using cavernoscopy during removal of an inflatable penile prosthesis. To our knowledge our case represents the first in which a cystoscope was used to perform cavernoscopy for this purpose. CASE REPORT A 61-year-old man with a history of multiple sclerosis presented with infection and erosion of a penile prosthesis through the distal right corporeal body. An inflatable 3-piece penile prosthesis had been placed at our institution 8 years ago. The implant was used satisfactorily until 1 month before presentation, when the patient was hospitalized for congestive heart failure and pneumonia. During the prolonged hospitalization several Foley catheters were placed for strict fluid management on different occasions. Physical examination demonstrated extrusion of the right cylinder through the distal end of the corpus cavernosum and glans. At surgery a midline scrotal incision was made and purulent material was drained from the scrotum. Scrotal cultures were obtained and the scrotal cavity was copiously irrigated with an antibiotic solution. The left corpus was entered ventrolaterally through a vertical penoscrotal incision and the left cylinder, including the rear tip extender, was removed without difficulty. The scrotal pump was removed by cutting its attachments to the cylinders. The right cylinder was removed through the area of perforation in the distal glans. However, we soon realized that the rear tip extender had not been removed. After the usual blind attempts to remove the right extender failed cavernoscopy was performed using a 19F rigid cystoscope sheath and a 0-degree lens. The interior of the corpora cavernosa was visualized and the cystoscope was advanced toward the proximal corpus. The rear tip extender