(002) Surgical Management of Proximal and Distal Corporal Perforation in Inflatable Penile Prosthesis Revision: A Video Presentation

Abstract Introduction Revision surgery for inflatable penile prosthesis (IPP) following infection poses significant challenges due to the presence of dense corporal fibrosis. Such fibrosis complicates cylinder placement and increases the risk of intraoperative complications, including corporal perforation. Video-based demonstrations provide valuable educational insights into the recognition and surgical management of these complex scenarios. Objective To present a video-based case highlighting the intraoperative identification and management of proximal and distal corporal perforations encountered during IPP revision surgery in the setting of severe corporal fibrosis. Methods A patient underwent revision IPP surgery following prior device explantation for infection. Dense fibrosis was encountered, more pronounced in the left corpora. During corporal dilation, both proximal and distal perforations were identified. These complications were documented in real time as part of an operative video. The surgical steps undertaken to recognize and address the perforations are demonstrated, including strategies to re-establish correct corporal tracts and stabilize cylinder placement. Results Both proximal and distal perforations were identified intraoperatively. The proximal perforation was managed with redirection of dilation and placement of a sling suture. The distal perforation was managed by extending the wound and performing an additional distal corporotomy. All maneuvers were successfully completed during the same operative session. At the conclusion of the procedure, functional device cycling was achieved without evidence of further malposition. The video illustrates practical techniques for surgeons managing similar scenarios. Conclusions Corporal fibrosis following infected IPP explantation significantly increases the risk of corporal perforation during revision surgery. Intraoperative recognition of proximal and distal perforations is essential to ensure safe device implantation and to avoid postoperative extrusion, device displacement, or mechanical dysfunction. This video presentation demonstrates step-by-step methods for identifying perforations and implementing effective intraoperative solutions. The case underscores the importance of meticulous technique, anticipation of complications, and readiness to apply corrective measures in challenging revision prosthetic surgery. Disclosure No