(320) Novel J-Shaped Pump Repositioning Approach in Penile Prosthesis Revision Surgery

Abstract Introduction Penile prosthesis implantation remains the gold standard treatment for men with refractory erectile dysfunction, providing reliable restoration of sexual function and high patient satisfaction rates. Despite advances in surgical techniques and device design, complications still arise. Among these, pump malposition represents a challenging issue that can lead to pain, mechanical dysfunction, and, if uncorrected, scrotal erosion with subsequent infection and potential device explantation. Early recognition and appropriate revision are essential to preserve device integrity and ensure long-term success. Objective In this video, we present a novel revision technique using a J-shaped tubing configuration designed to stabilize the pump, reduce mechanical tension, and prevent recurrent migration. Methods We present the case of a patient with an inflatable penile prosthesis (IPP) who developed a malpositioned pump that had migrated superficially against the scrotal wall. Surgical exploration was performed through a longitudinal scrotal incision over the pump. Careful dissection was undertaken to mobilize the pump from the dense adhesions and fibrous tissue capsule that had formed around it. The capsule was completely excised to allow free mobilization of the device and to prevent recurrence of adherence. Because the connecting tubing length was excessive, direct shortening or trimming was avoided to reduce the risk of subsequent leakage or mechanical malfunction. Instead, a novel intra-scrotal repositioning technique was utilized. The redundant tubing was configured in a smooth J-shaped loop within the dependent portion of the scrotum, thereby relieving traction forces and preventing kinking. At the corner of the J-loop, the tubing was secured with a 2-0 PDS suture to maintain the configuration and stability. The pump itself was then anchored in an anatomically dependent and accessible position, ensuring both patient comfort and ease of manipulation. Hemostasis was achieved, and the incision was closed in layers in the standard fashion. Results The procedure was completed without intraoperative complications. The pump was successfully repositioned into a dependent and accessible location within the scrotum, with the tubing secured in a stable J-loop configuration. Postoperatively, the patient had no wound-related complications. Early activation testing demonstrated smooth pump function, with effortless inflation and deflation. At follow-up, the patient reported marked improvement in ease of use and was able to cycle the device independently without difficulty. No recurrence of malposition, pump migration, or signs of impending erosion were observed during the follow-up period. Overall, the novel repositioning technique provided a durable and functional solution while preserving the integrity of the prosthesis system. Conclusions This case highlights the importance of timely surgical revision in patients with malpositioned IPP pumps to avoid progression to scrotal erosion and potential device loss. By excising the fibrous capsule and employing a novel J-shaped repositioning technique, the pump was stabilized in a functional position without compromising tubing integrity. The use of a J-loop not only relieved excess tension but also provided durable fixation and preserved device function. This approach represents a simple, safe, and effective option for managing complex pump malpositions, and may be particularly useful for surgeons encountering similar revision challenges in prosthetic urology. Disclosure No