Extracapsular Tunneling for the Management of Impending Cylinder Erosion

Author: Jonathan Clavell-Hernández, MD

Key Words: Inflatable penile prosthesis, Extracapsular Tunneling, Impending Erosion, Cylinder Extrusion

Impending erosion, or extrusion, of the distal cylinders is a complication which may cause cosmetic deformity or pain and may lead to patient dissatisfaction, device infection and erosion with subsequent inflatable penile prosthesis (IPP) removal. There are multiple approaches that have been described to manage this rare complication, many of which include a counter-incision(Mulcahy). Shaeer previously described the use of ‘extracapsular implantation’ to avoid implant reinfection during salvage cases (Shaeer et al). We believe this technique can be extrapolated to include cases of extrusion. This video shows the use of ‘extracapsular tunneling’ for the management of impending cylinder erosion at the time of IPP revision. Through a penoscrotal approach (although this technique can be performed through an infrapubic approach), the posterior wall of the capsule is superficially incised until the surgeon is able to identify the sinusoidal tissue surrounding the capsule. An extracapsular tunnel is then created and the stay sutures are placed at the edges of both the capsule and the corporotomy’s tunica albuginea. The IPP is then placed through the new extracapsular sinusoidal space which will collapse the intracapsular space when inflated. In summary, the extracapsular tunneling technique provides for an alternative method for management of distal impending erosion at the time of IPP revision without the use of a counter-incision.

Acknowledgement: None

Disclosures: Consultant – Boston Scientific, Coloplast

References:

1. Mulcahy JJ. Distal corporoplasty for lateral extrusion of penile prosthesis cylinders. J Urol 1999;161:193-5.
2. Shaeer O, Shaeer K, AbdelRahman IFS. Salvage and extracapsular implantation for penile prosthesis infection or extrusion. J Sex Med 2019;16:755-59.