Distal penile prosthesis extrusion: treatment with distal corporoplasty or Gortex windsock reinforcement

Abstract

Subcutaneous extrusion of penile prosthesis cylinders beneath the glans penis is an unusual but difficult complication of penile prosthesis. Without surgical repair, extrusion, infection, and corporeal fibrosis may ensue. Twenty-eight patients with distal corporeal extrusion were reviewed to identify the optimum treatment outcome for these penile prosthesis complications. Records of 28 men with subcutaneous distal penile prosthesis cylinder extrusion were reviewed. Mean age was 56.2 y. Etiology of erectile dysfunction was diabetes mellitus in 11, vasculogenic in 10, Peyronie's disease in five, radical pelvic surgery in five. Duration of penile prosthesis was 8 -72 months (mean 42.6). No patient had penile prosthesis infection or device exposure through the skin. Distal corporoplasty was treated on 18=28 men using cylinder repositioning and direct tunica albuginea repair. Ten men underwent repair using a Gortex windsock. 8=18 corporoplasty and 6=10 windsock patients required glans fixation for treatment of hypermobile glans following cylinder relocation. In two patients with windsock repair, extrusion recurrence occurred 6 and 18 months following surgery and 1=6 had post operative infection requiring prosthesis removal. Mean surgical time for corporoplasty was 52.8 minutes while windsock reconstruction was 89.6 minutes. Distal subcutaneous penile prosthesis cylinder extrusion produces coital pain and predisposes to cylinder exposure and infection. Early repair with or without additional prosthetic materials will return penile prostheses to a normal functioning state. Distal corporoplasty with cylinder repositioning appears to be a simple, low morbidity solution to this difficult dilemma. Outcomes with distal corporoplasty result in better function, less pain, and fewer recurrences than Gortex windsock repair.

Current use of penile implants in erectile dysfunction

“…This substitutes one foreign body close to the skin surface for another. Carson and Noh [24] compared the two techniques, natural tissue repair versus windsock, and found that the former was more successful.…”

Management of intraoperative penile implant complications

“…Organic tissue grafts, such as pericardium, have been shown to be good substitutes for synthetic material in grafting of the tunica albuginea [40,41]. Use of natural tissue repairs and organic grafts has proven to be a superior solution for tunica albuginea defects, as it avoids the increased risk of infection associated with the use of synthetic grafts and penile implants [38]. The IPP of choice for patients with tunica albuginea defects is the 700 CX (controlled expansion) (American Medical Systems, Minneapolis, MN) because the controlled expansion limits the chance of an aneurysm formation.…”

“…Traditional correction for proximal perforation involved the use of synthetic graft material to form a "windsock." Use of synthetic grafts in repairs of the tunica albuginea with penile implants resulted in infection rates as high as 30% [34,38]. This increased infection rate is thought to be due to bacteria being able to grow in the protected environment between two synthetic surfaces-the graft and the penile implant [17].…”

Updates in Inflatable Penile Prostheses

“…The use of synthetic grafts resulted in infection rates as high as 30% [40,42], purportedly because bacteria are able to grow in the protected environment between two synthetic surfaces (ie, the graft and the penile implant) [13]. Organic tissue grafts, such as cadaver pericardium, have been shown to be good grafting material [43,44], avoiding this increased risk of infection [42]; however, in our opinion, they are not necessary with stabilization of the cylinder base out of the perforation as outlined previously.…”