Skip to main content
SpringerLink
Log in

Management of Urethral Injury During Penile Prosthesis Surgery

  • Male and Female Surgical Interventions (C Carson and P Selph, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There has been relatively little research into the management of intraoperative urethral injury during insertion of penile prostheses. In this review, we describe how such injuries can occur and the common management strategies.

Recent Findings

There are no randomized trials or level 1 evidence for managing such intraoperative urethral injury, and most literature are small retrospective series, expert opinions, or systematic reviews that combine small observational studies. Anatomical considerations, corporal fibrosis, and Peyronie’s disease present risk factors for urethral injury. Injuries can be classified by location at the distal urethra (meatus to fossa navicularis), mid-urethra (fossa navicularis through pendulous urethra), or proximal urethra (proximal penile urethra to distal bulbar urethra). There is no true consensus on what actions to take when a urethral injury does occur, and management is changing over time. While the traditional course has been to abort the procedure, some surgeons now choose to repair the defect and proceed with prosthesis implantation.

Summary

Urethral injury is a rare but serious complication during penile prosthesis insertion. Management is heterogenous and is heavily dependent on the location of the injury and the preference and experience of the surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Carlos EC, Sexton SJ, Lentz AC. Urethral injury and the penile prosthesis. Sex Med Rev. 2019;7(2):360–8 Review of the common causes of urethral injury during penile prosthesis implantation and possible management methods.

    Article  Google Scholar 

  2. Palma-Zamora I, Sood A, Dabaja AA. 30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation. Transl Androl Urol. 2017;6(Suppl 5):S767–73.

    Article  Google Scholar 

  3. Chung E, van C, Wilson I, Cartmill RA. Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures. World J Urol. 2013;31(3):591–5.

    Article  CAS  Google Scholar 

  4. Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int. 2006;97(1):129–33.

    Article  Google Scholar 

  5. •• Sexton SJ, Granieri MA, Lentz AC. Survey on the contemporary management of intraoperative urethral injuries during penile prosthesis implantation. J Sex Med. 2018;15(4):576–81 Survey of 131 urologists on their complication rates and preferred management techniques of urethral injury during penile prosthesis implantation.

    Article  Google Scholar 

  6. Hsu GL, Brock G, Martínez-Piñeiro L, von Heyden B, Lue TF, Tanagho EA. Anatomy and strength of the tunica albuginea: its relevance to penile prosthesis extrusion. J Urol. 1994;151(5):1205–8.

    Article  CAS  Google Scholar 

  7. Hofer MD, Morey AF, Sheth K, Tausch TJ, Siegel J, Cordon BH, et al. Low serum testosterone level predisposes to artificial urinary sphincter cuff erosion. Urology. 2016;97:245–9.

    Article  Google Scholar 

  8. Henry GD, Mahle P, Caso J, Eisenhart E, Carrion R, Kramer A. Surgical techniques in penoscrotal implantation of an inflatable penile prosthesis: a guide to increasing patient satisfaction and surgeon ease. Sex Med Rev. 2015;3(1):36–47.

    Article  Google Scholar 

  9. Rajpurkar A, Li H, Dhabuwala CB. Penile implant success in patients with corporal fibrosis using multiple incisions and minimal scar tissue excision. Urology. 1999;54(1):145–7.

    Article  CAS  Google Scholar 

  10. • Antonini G, et al. Inflatable penile prosthesis placement, scratch technique and postoperative vacuum therapy as a combined approach to definitive treatment of Peyronie’s disease. J Urol. 2018;200(3):642–7 Specific technical option when encountering a plaque due to Peyronie’s disease and post-operative therapeutic outcomes.

    Article  Google Scholar 

  11. Shaeer O. Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med. 2007;4(3):809–14.

    Article  Google Scholar 

  12. • Stember DS, Kohler TS, Morey AF. Management of Perforation Injuries During and Following Penile Prosthesis Surgery. J sex med. 2015;12 Suppl(7):456–61 Review of urethral perforation injuries and management strategies during penile prosthesis implantation.

    Article  Google Scholar 

  13. Anaissie J, Yafi FA. A review of surgical strategies for penile prosthesis implantation in patients with Peyronie’s disease. Transl Androl Urol. 2016;5(3):342–50.

    Article  Google Scholar 

  14. Mulhall J, Ahmed A, Anderson M. Penile prosthetic surgery for Peyronie's disease: defining the need for intraoperative adjuvant maneuvers. J Sex Med. 2004;1(3):318–21.

    Article  Google Scholar 

  15. Yafi FA, Sangkum P, McCaslin I, Hellstrom WJ. Strategies for penile prosthesis placement in Peyronie’s disease and corporal fibrosis. Curr Urol Rep. 2015;16(4):21.

    Article  Google Scholar 

  16. • Mulcahy JJ. The prevention and management of noninfectious complications of penile implants. Sex Med Rev. 2015;3(3):203–13 Review of various classifications of penile prostheses complications.

    Article  Google Scholar 

  17. • Minhas S. Urethral perforation during penile implant surgery: what to do? J Sex Med. 2017;14(7):867–9 Review of urethral perforation injuries and management strategies during penile prosthesis implantation.

    Article  Google Scholar 

  18. Bettocchi C, D.P., Palumbo F, Lucarelli G, Garaffa G, Giammusso B, Battaglia M., Penile prosthesis: what should we do about complications? Adv Urol, 2008: p. 573560.

  19. Sadeghi-Nejad H. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med. 2007;4(2):296–309.

    Article  Google Scholar 

  20. Urethral injury during inflatable penile prosthesis: a new repair. VJPU. 2014;1:104.

  21. • Anele UA, Le BV, Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation. Sex Med. 2014;2(4):178–81 Supports use of suprapubic cystostomy to manage urethral injuries.

    Article  Google Scholar 

  22. Henry GD. The Henry mummy wrap and the Henry finger sweep surgical techniques. J Sex Med. 2009;6(3):619–22.

    Article  Google Scholar 

  23. • Yi YA, et al. Synchronous urethral repair during prosthetic surgery: safety of planned and damage control approaches using suprapubic tube urinary diversion. J Sex Med. 2019;16(7):1106–10 Advocates for repair of urethral injury and suprapubic tube insertion at the time of injury.

    Article  Google Scholar 

  24. Steidle CP, Mulcahy JJ. Erosion of penile prostheses: a complication of urethral catheterization. J Urol. 1989;142(3):736–9.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Robert B. Qi and Dominic C. Grimberg contributed equally to this work.

Authors and Affiliations

  1. Division of Urology Surgery, Duke University Medical Center, 3480 Wake Forest Rd, Suite 506, Raleigh, NC, 27609, USA

    Robert B. Qi, Dominic C. Grimberg & Aaron C. Lentz

Authors
  1. Robert B. Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dominic C. Grimberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aaron C. Lentz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron C. Lentz.

Ethics declarations

Conflict of Interest

Dr. Qi, and Dr. Grimberg declare that they have no conflicts of interest. Dr. Lentz reports serving as a consultant, speaker, and preceptor for Boston Scientific and Coloplast.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Male and Female Surgical Interventions

Electronic Supplementary Material

Video 1

(MP4 4969 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qi, R.B., Grimberg, D.C. & Lentz, A.C. Management of Urethral Injury During Penile Prosthesis Surgery. Curr Sex Health Rep 12, 62–67 (2020). https://doi.org/10.1007/s11930-020-00259-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-020-00259-3

Keywords

Search

Navigation