Abstract Introduction Surgical correction of penile curvature due to Peyronie’s disease often involves shortening the longer side of the penis using techniques collectively referred to as shortening corporoplasty, based on the Nesbit procedure. Although these procedures are effective, they are associated with some degree of penile length loss, which is frequently one of the primary concerns raised by patients during preoperative counselling. Urethral injury during penile prosthesis placement is rare but feared, particularly in hostile operative fields such as multiply re-operated, post-infection or irradiated corpora. Immediate salvage strategies include aborting the procedure, primary urethral repair, or conversion to a malleable prosthesis to preserve corporal space. We present a case of intraoperative urethral injury managed with a deliberately shortened malleable prosthesis as an immediate salvage approach. Objective this study aim to demonstrate a safe salvage procedure to offere in selective case of urethral injury at the time of Ipp insertion Methods A 62-year-old man with a complex history of multiple pelvic and penile surgeries underwent inflatable penile prosthesis (IPP) re-implantation in 2025. Dense corporal fibrosis was encountered, and a distal urethral injury was identified during dilatation. Given the patient’s extensive surgical history including explantation of infected penile implant and irradiated tissue, immediate malleable salvage was undertaken. The malleable device was intentionally shortened to reduce risk of distal urethral erosion and infection while preserving the corporal compartment for future prosthesis conversion. Results The procedure was completed without further intraoperative or early postoperative complications. Corporal length was preserved, and the urethra was protected with an indwelling catheter for two weeks. Delayed conversion to an inflatable prosthesis remains feasible pending urethral healing and functional recovery. Conclusions Intraoperative urethral injury during IPP revision in a heavily pre-treated penis represents a true surgical “nightmare”. Immediate malleable prosthesis salvage is a safe, damage-control strategy that avoids staged implantation and maintains corporal architecture in hostile, fibrotic cases. This video demonstrates real-time injury recognition, surgical decision-making, and malleable downsizing as a pragmatic, organ-preserving solution. Disclosure No
Giovanni et al. (Mon,) studied this question.