Revision of Penile Prosthesis Surgery after Use of Penile Traction Therapy to Increase Erect Penile Length: Case Report and Review of the Literature

Abstract

Erectile dysfunction, a common consequence of radical prostatectomy (RP), can be managed with placement of a penile prosthesis. Patient satisfaction and functional outcomes have been related to penile length after prosthesis placement. We report a case demonstrating the impact of daily penile traction therapy in a patient with a previously placed penile prosthesis with the goal of enabling revision with a longer device. A post-RP patient who underwent inflatable penile prosthesis placement 6 years ago complained of inability to maintain partner penetration with his device. The patient underwent vacuum erection device therapy twice daily for 10 minutes per session for approximately 1 year as well as 8 hours of penile traction therapy daily for 8 months. A revision implant surgery was subsequently attempted. Patient reported functional outcome. Stretched penile length increased 2.3 cm after 6 months of traction therapy. A revision surgery enabled the placement of a prosthesis that was 20% longer in length (15 cm to 18 cm), and erect penile length increased by 4.4 cm. The patient reported that the new prosthesis enabled satisfactory maintenance of partner penetration. This case suggests that the use of a penile traction device increases penile corporal length, and thus the length of a penile prosthesis that can be implanted in a patient with an unsatisfactory prosthesis already in place. Importantly, this patient experienced a substantial improvement in erect penile length after surgery. It is unknown whether these results are generalizable, either to all patients with a previously placed prosthesis or pre-prosthesis patients, representing an opportunity for further investigation.