Penile Prosthesis Implantation in Complex and Previously Failed Settings

  • Sevann Helo
  • Jonathan Clavell-Hernandez
  • Steven K. Wilson
  • Tobias S. KöhlerEmail author


The most common reasons for revision surgery of penile prostheses include mechanical failure, infection and patient dissatisfaction. While revisions for mechanical failure and patient dissatisfaction are relatively routine surgical procedures, penile prosthesis implantation in previously failed settings is daunting, even for the experienced implanter. The surgical planes are altered and obliterated by scar. To maximize success, specialized instruments, downsized implants and lots of experience are necessities. Even experienced implanters without these assets have a high complication rate. Even if a surgical victory is achieved for the surgeon, the patient may be unhappy about his loss of length. This chapter is meant as a guide to the focused implanter for navigating the tricky pathways of redo of multi component prosthetics. We hope to help the reader prevent mistakes and reward realistic patient expectations in this difficult surgery on discouraged patients.


Implant revision Corporal fibrosis Stenotic corpora Priapism Implant infection Hypermobile glans Impending erosion Cavernotomes 


  1. 1.
    Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable inflatable penile prostheses: single surgical group experience with 2384 first-time implants spanning two decades. J Sex Med. 2007;4:1074–9.PubMedGoogle Scholar
  2. 2.
    Henry GD, Kansal NS, Callaway M, Grigsby T, Henderson J, Noble J, et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol. 2009;181:1264–8.PubMedGoogle Scholar
  3. 3.
    Kava BR, Yang Y, Soloway CT. Efficacy and patient satisfaction associated with penile prosthesis revision surgery. J Sex Med. 2007;4:509–18.PubMedGoogle Scholar
  4. 4.
    Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50–5.PubMedGoogle Scholar
  5. 5.
    Tiefer L, Moss S, Melman A. Follow-up of patients and partners experiencing penile prosthesis malfunction and corrective surgery. J Sex Marital Ther. 1991 Summer;17:113–28.PubMedGoogle Scholar
  6. 6.
    Henry GD, Donatucci CF, Conners W, et al. An outcomes analysis of over 200 revision surgeries for penile prosthesis implantation: a multicenter study. J Sex Med. 2012;9:309–15.PubMedGoogle Scholar
  7. 7.
    Henry GD, Wilson SK, Delk JR 2nd, et al. Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study. J Urol. 2005;173:89–92.PubMedGoogle Scholar
  8. 8.
    Garber BB, Khurgin JL, Stember DS, Perito PE. Pseudo-malfunction of the coloplast titan inflatable penile prosthesis one-touch release pump. Urology. 2014;84:857–9.PubMedGoogle Scholar
  9. 9.
    Brant MD, Ludlow JK, Mulcahy JJ. The prosthesis salvage operation: immediate replacement of the infected penile prosthesis. J Urol. 1996;155:155–7.PubMedGoogle Scholar
  10. 10.
    Wilson SK, Delk JR 2nd. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995;153:659–61.PubMedGoogle Scholar
  11. 11.
    Carson CC 3rd. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol. 2004;171:1611–4.PubMedGoogle Scholar
  12. 12.
    Wolter CE, Hellstrom WJ. The hydrophilic-coated inflatable penile prosthesis: 1-year experience. J Sex Med. 2004;1:221–4.PubMedGoogle Scholar
  13. 13.
    Wilson SK, Zumbe J, Henry GD, Salem EA, Delk JR, Cleves MA. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology. 2007;70:337–40.PubMedGoogle Scholar
  14. 14.
    Silverstein AD, Henry GD, Evans B, Pasmore M, Simmons CJ, Donatucci CF. Biofilm formation on clinically noninfected penile prostheses. J Urol. 2006;176:1008–11.PubMedGoogle Scholar
  15. 15.
    Kava BR, Kanagarajah P, Ayyathurai R. Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single-surgeon series. J Sex Med. 2011;8:1540–6.PubMedGoogle Scholar
  16. 16.
    Montgomery BD, Lomas DJ, Ziegelmann MJ, Trost LW. Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories. Int J Impot Res. 2018;30:147–52.PubMedGoogle Scholar
  17. 17.
    Levine LA, Becher EF, Bella AJ, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016;13:489–518.PubMedGoogle Scholar
  18. 18.
    Mulcahy JJ. The prevention and management of noninfectious complications of penile implants. Sex Med Rev. 2015;3:203–13.PubMedGoogle Scholar
  19. 19.
    Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3:736–42.PubMedGoogle Scholar
  20. 20.
    Sellers T, Dineen M, Salem EA, Wilson SK. Vacuum preparation, optimization of cylinder length and postoperative daily inflation reduces complaints of shortened penile length following implantation of inflatable penile prosthesis. Adv Sex Med. 2013;3:14–8.Google Scholar
  21. 21.
    Martinez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med. 2011;8:1880–9.PubMedGoogle Scholar
  22. 22.
    Wilson SK. Reimplantation of inflatable penile prosthesis into scarred corporeal bodies. Int J Impot Res. 2003;15(Suppl 5):S125–8.PubMedGoogle Scholar
  23. 23.
    Gasser TC, Larsen EH, Bruskewitz RG. Penile prosthesis reimplantation. J Urol. 1987;137:46–7.PubMedGoogle Scholar
  24. 24.
    Rajpurkar A, Li H, Dhabuwala CB. Penile implant success in patients with corporal fibrosis using multiple incisions and minimal scar tissue excision. Urology. 1999;54:145–7.PubMedGoogle Scholar
  25. 25.
    George VK, Shah GS, Mills R, Dhabuwala CB. The management of extensive penile fibrosis: a new technique of ‘minimal scar-tissue excision’. Br J Urol. 1996;77:282–4.PubMedGoogle Scholar
  26. 26.
    Shaeer O, Shaeer A. Corporoscopic excavation of the fibrosed corpora cavernosa for penile prosethesis implantation: optical corporotomy and trans-corporeal resection, Shaeer’s technique. J Sex Med. 2007;4:218–25.PubMedGoogle Scholar
  27. 27.
    Wilson SK. Rear tip extender sling: a quick and easy repair for crural perforation. J Sex Med. 2010;7:1052–5.PubMedGoogle Scholar
  28. 28.
    Fuchs JS, Shakir N, McKibben MJ, Mathur S, Teeple S, Scott JM, et al. Penoscrotal decompression-promising new treatment paradigm for refractory ischemic priapism. J Sex Med. 2018;15(5):797–802.PubMedGoogle Scholar
  29. 29.
    Ralph DJ, Borley NC, Allen C, et al. The use of high-resolution magnetic resonance imaging in the management of patients presenting with priapism. BJU Int. 2010;106:1714–8.PubMedGoogle Scholar
  30. 30.
    Yucel OB, Pazir Y, Kadioglu A. Penile prosthesis implantation in priapism. Sex Med Rev. 2018;6:310–8.PubMedGoogle Scholar
  31. 31.
    Rees RW, Kalsi J, Minhas S, Peters J, Kell P, Ralph DJ. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int. 2002;90:893–7.PubMedGoogle Scholar
  32. 32.
    Ralph DJ, Garaffa G, Muneer A, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009;56:1033–8.PubMedGoogle Scholar
  33. 33.
    Rossello Barbara M, Carrion H. Cavernotomy. Arch Esp Urol. 1991;44:185–6.PubMedGoogle Scholar
  34. 34.
    Mooreville M, Adrian S, Delk JR 2nd, Wilson SK. Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome. J Urol. 1999;162:2054–7.PubMedGoogle Scholar
  35. 35.
    Knoll LD. Use of penile prosthetic implants in patients with penile fibrosis. Urol Clin North Am. 1995;22:857–63.PubMedGoogle Scholar
  36. 36.
    Herschorn S, Ordorica RC. Penile prosthesis insertion with corporeal reconstruction with synthetic vascular graft material. J Urol. 1995;154:80–4.PubMedGoogle Scholar
  37. 37.
    Lopes EJ, Santos TC, Jacobino M. Bovine pericardium in penile prosthesis reimplantation. Int Braz J Urol. 2007;33:74–6.PubMedGoogle Scholar
  38. 38.
    Palese MA, Burnett AL. Corporoplasty using pericardium allograft (tutoplast) with complex penile prosthesis surgery. Urology. 2001;58:1049–52.PubMedGoogle Scholar
  39. 39.
    Lopes EJ, Kuwano AY, Guimaraes AN, Flores JP, Jacobino MA. Corporoplasty using bovine pericardium grafts in complex penile prosthesis implantation surgery. Int Braz J Urol. 2009;35:49–53; discussion -5.PubMedGoogle Scholar
  40. 40.
    Tran VQ, Lesser TF, Kim DH, Aboseif SR. Penile corporeal reconstruction during difficult placement of a penile prosthesis. Adv Urol. 2008:370947.Google Scholar
  41. 41.
    Pathak AS, Chang JH, Parekh AR, Aboseif SR. Use of rectus fascia graft for corporeal reconstruction during placement of penile implant. Urology. 2005;65:1198–201.PubMedGoogle Scholar
  42. 42.
    Kim ED, McVary KT. Long-term followup of treatment of Peyronie’s disease with plaque incision, carbon dioxide laser plaque ablation and placement of a deep dorsal vein patch graft. J Urol. 1995;153:1843–6.PubMedGoogle Scholar
  43. 43.
    Melman A, Holland TF. Evaluation of the dermal graft inlay technique for the surgical treatment of Peyronie’s disease. J Urol. 1978;120:421–2.PubMedGoogle Scholar
  44. 44.
    Hatzichristodoulou G, Gschwend JE, Lahme S. Surgical therapy of Peyronie’s disease by partial plaque excision and grafting with collagen fleece: feasibility study of a new technique. Int J Impot Res. 2013;25:183–7.PubMedGoogle Scholar
  45. 45.
    Kohler TS, Gupta NK, Wilson SK. Wilson’s pearls, perils and pitfalls of penile prosthesis surgery. Fort Smith: Calvert McBride Publishers; 2018.Google Scholar
  46. 46.
    Cefalu CA, Deng X, Zhao LC, Scott JF, Mehta S, Morey AF. Safety of the “drain and retain” option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013;82:1436–9.PubMedGoogle Scholar
  47. 47.
    Mulcahy JJ. Distal corporoplasty for lateral extrusion of penile prosthesis cylinders. J Urol. 1999;161:193–5.PubMedGoogle Scholar
  48. 48.
    Ball TP Jr. Surgical repair of penile “SST” deformity. Urology. 1980;15:603–4.PubMedGoogle Scholar
  49. 49.
    Ziegelmann MJ, Alom M, Bole R, Kohler T, Trost L. Modified glanulopexy technique for supersonic transporter deformity and glanular hypermobility in men with penile prostheses. J Sex Med. 2018;15:914–9.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sevann Helo
    • 1
  • Jonathan Clavell-Hernandez
    • 2
  • Steven K. Wilson
    • 3
  • Tobias S. Köhler
    • 4
    Email author
  1. 1.Minneapolis VA Health Care System, Division of UrologyMinneapolisUSA
  2. 2.St Joseph Medical CenterHoustonUSA
  3. 3.Institute for Urologic ExcellenceLa QuintaUSA
  4. 4.Mayo Clinic, Department of UrologyRochesterUSA

Personalised recommendations