Troubleshooting intraoperative complications of penile prosthesis placement

Abstract

Placement of a penile prosthesis is an excellent option for well-selected patients, offering high patient satisfaction and a low rate of complications. Most urologists who perform the procedure are not high volume implanters and may have limited experience with troubleshooting intraoperative issues. In this review, the authors use current literature to provide recommendations for the management of various intraoperative issues such as difficultly with dilation, incongruent measurement, perforation, urethral injury, crossover, complications of reservoir placement, penile curvature, glans mobility, and hemostasis are all discussed. Preparedness for the management of intraoperative issues can help improve patient outcomes and limit morbidity.

Successful Use of an Inflatable Penile Prosthesis for the Treatment of Distal Deficiency of the Tunica Albuginea and Cavernous Tissue

“…Evidence has shown that multilayer dartos closure may be associated with improved patient satisfaction and may help prevent future complications 7, 8. Furthermore, the use of Metzenbaum scissors to aid in distal corporal dilation has been reported to be a suitable technique 9 . Manual modeling was also used in this scenario, because the patient's curvature could not be assessed or predicted preoperatively, which was likely secondary to a lack of blood flow over time.…”

An update on the best approaches to prevent complications in penile prosthesis recipients

“…35 Decreased glans sensation remains a theoretical risk with an infrapubic approach or surgical correction of glans hypermobility, but reported rates of this are low. 22,32 Glans ischemia is a rare complication associated with cardiovascular disease, poorly controlled diabetes, smoking, radiation, and prior prosthesis, and is thought to be related to disruption of glanular blood supply via the dorsal penile arteries and corpus spongiosum muscle. Risk of this complication can be minimized by avoiding subcoronal incisions, concomitant circumcision or penile degloving in high-risk patients.…”

“…31 Leaving the device deflated for 6 months allows this to heal in place. 29,32 Distal corporal perforation or crossover can be ruled out by placement of simultaneous distal dilators. Crossover should be considered when dilator contact is noted distally.…”

“…This can be managed by re-dilating the perforated side with a dilator in the uninjured side, with placement of the cylinder while leaving the dilator in the contralateral cavity. 32 When a distal perforation or crossover is noted, careful inspection should be performed to rule out urethral perforation by irrigating the corpora. The corpora should tumesce without drainage of irrigation around the urethral catheter.…”

Inflatable penile prosthesis in the radical prostatectomy patient: a review

“…In addition, the initial correct distal tunneling technique using laterally directed dilators will help avoid crossover 28 . Side-by-side placement of the Brooks or Hagar dilators in each corpus to check for symmetry and proper positioning is the best way to check for proximal or distal crossover 34 . If a crossover is detected, the dilator may simply be redirected with the contralateral dilator left in place to prevent repeat crossover 28 .…”