The Prevention and Management of Noninfectious Complications of Penile Implants

Troubleshooting intraoperative complications of penile prosthesis placement

“…A proximal perforation should be addressed with the creation of a sling to prevent proximal migration of the cylinder. This is described well by Mulcahy ( 7 ). First, a double swedged permanent suture is placed through the proximal cylinder or rear tip extender.…”

“…If other etiologies of fibrosis are expected, mid-corporal corporotomies are helpful to minimize the length of dilation required in a single direction. For example, a penoscrotal incision may be chosen over a perineal incision or an infrapubic incision over a subcoronal incision ( 7 ).…”

“…A catheter can be placed, but prolonged catheter placement is not necessary. The urinary stream will preferentially draw fluid into itself and out of the urethra rather than infiltrate the corporal defect ( 7 ). Prolonged catheter placement may even increase the risk of stricture.…”

“…The corporotomy is closed primarily, and the sling suture is tied above the closure. Cutting the permanent suture of the sling two to three centimeters from the knot allows for easier identification and removal for cylinder replacement in the future, if needed ( 7 ). Detailed understanding of this technique will allow for confident completion of implantations complicated by proximal perforations.…”

“…Certain patient factors such as prior robotic-assisted laparoscopic prostatectomy or radical cystectomy can further complicate the anatomy by violating the space of Retzius. Scarring can be present from other prior abdominal surgeries, pelvic radiation, or from urinoma after anastomotic leak of a urethral anastomosis ( 7 ). This can lead to more complications with reservoir placement, especially among inexperienced surgeons.…”