Distal Corporoplasty to Treat Distal Penile Prosthesis Extrusion

Carrino Maurizio1, Chiancone Francesco1, Pucci Luigi1, Fedelini Paolo2
1: Andrological Surgery Department, A.Cardarelli Hospital, Naples, Italy
2: Urology Department, A.Cardarelli Hospital, Naples, Italy

Introduction: Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. If the cylinders are not exposed to the exterior, this complication can be solved with a surgical procedure called "Distal Corporoplasty". The authors show this procedure step by step.
Case Presentation: A 57-year-old man underwent implantation of an "SSDA Subrini soft implant" penile prosthesis for vasculogenic erectile dysfunction in January 2014. After implantation he underwent two failed glandulopexy (March and July 2014) for bilateral distal cylinder extrusion. In July 2015 he reached our department with bilateral distal cylinders extrusion without infection and without exposition to the exterior. We performed a "distal corporoplasty" with simultaneous reimplantation of an “AMS 700 Inflatable Penile Prosthesis (LGX)”.
Protocol: A sub coronal dorsal hemicircumcising incision is made. A longitudinal corporotomy is made over the cylinder on the anterior wall of the pseudocapsule. The cylinder is removed exposing the posterior wall of the pseudocapsule. This wall is incised transversely and the plane of spongy tissue behind the pseudocapsule is opened to the distal end of the corporal body with scissors and a new dilation is performed with brooks dilators. This procedure is performed bilaterally. A penoscrotal incision is made and a tricomponent penile prosthesis is implanted into the new created space. The reservoir is placed into the space of Retzius. The corporotomies are closed with a 3-0 vicryl suture, without closing the old tract. The new prosthesis is left partially inflated. A closed suction drain is inserted and a pressure dressing is performed to prevent scrotal hematoma.
Outcome: Two months after the procedure, the patient had sexual intercourse for the first time post-surgery. No complications were demonstrated at the fourth month postoperative follow-up.
Discussion: Distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.