Cylinder Realignment for Impending Inflatable Penile Prosthesis Erosion

Abstract

ABSTRACT Introduction Due the low incidence of impending inflatable penile prosthesis (IPP) erosion, low volume implanters may be challenged by these cases. In many situations, capsule formation around the implant may suffice to hinder cylinder migration. Nevertheless, severe cases may require prompt recognition and repair otherwise will transform into infected implantations once the implant exits the skin. Objective In this step-by-step video we demonstrate the Mulcahy technique for distal corporoplasty and cylinder realignment performed on a case of impending left side IPP erosion. We hope this video serves as an instructive resource for treating these particular cases. Methods Our case was a male patient who had a previously challenging implant revision with difficult corporal dilation into severely scarred corporal bodies. This may have been the potential cause for this complication. Through a conventional penoscrotal access, we began by utilizing the cutting current to access and explant all components of the old implant. Due to the difficulty in reservoir removal, we opted to drain it and leave it in place (“Drain and retain”). In addition to the conventional instruments required for IPP implantation, the special instruments we utilized were the Wilson's backward cutting scissors as well as the Uramix cavernotomes (http://www.uramix.com/category/og/). A second small incision was performed localized at the site of presumed distal corporal perforation for access and repair of the problem. After creating the correct corporal pathway and obliterating the false track, hence concluding distal corporoplasty, a new IPP was implanted. The new reservoir was implanted ectopically, contralateral to the retained one. Although the original technique does not include device exchange and wash out, we preferred the latter to avoid the increased risk of infection associated with same device revision implantations. Results A new IPP was successfully implanted into the newly realigned distal corporal pathway. The patient demonstrated an eventless postoperative follow-up period. After 7 months of implant usage, the patient had a normal looking erect penis and was highly satisfied with his implant. Conclusions We consider the Mulcahy distal corporoplasty to be a safe and feasible approach to address the daunting complication of impending IPP cylinder erosion, excluding the need for total corporal exposure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast