(333) Replacement of Inflatable Penile Prosthesis in a Patient with Excessive Penile Filling Volume

Abstract Introduction Revision surgeries for inflatable penile prosthesis (IPP) implants are expected in up to 30% of cases within the first 10 years. Given the increasing life expectancy of the male population, and considering that IPP can be considered in the treatment of erectile dysfunction in younger patients, it is likely that many of these patients will require revision surgery at some point in their lives. In addition to a higher likelihood of postoperative infection, revision surgeries carry greater risk due to changes in surgical and anatomical planes, which can make it difficult to replace the entire device rather than just the malfunctioning component. Objective To present a case of replacement of an inflatable penile prosthesis in a 45-year-old man with excessive penile filling volume performed for aesthetic purposes. Methods A patient who underwent an IPP implant eight years ago for the treatment of premature ejaculation presented with mechanical failure of the prosthesis, unable to inflate it. He had undergone penile filler surgery for aesthetic purposes with hyaluronic acid approximately one year earlier. Physical examination of the genital region revealed a penis with a large volume of filler material, several nodules, deformities, and irregularities on its shaft, but with a free scrotum and an easily palpable pump. Pelvic resonance imaging described an apparently empty retropubic reservoir, while high-resolution ultrasound described between the Dartos and Buck fasciae, throughout the penis, a large quantity of anechoic deposits with suspended debris, certainly related to hyaluronic acid deposits, and in the dermis, areolar tissue and dissecting Buck's fascia, throughout the penis, a hyperchromic area was identified with a large amount of oily substance probably corresponding to silicone oil. Two applications of hyaluronidase were performed with a one-week interval in the penile filling region, and we scheduled the surgery to replace the IPP for 15 days after the second application of hyaluronidase. Results The surgical approach was performed through a transverse penoscrotal incision, allowing for easy access to the pump and connections. The location of the prosthesis' mechanical failure was quickly identified, resulting in a ruptured connection between the pump and one of the cylinders. On the ventral surface of the corpora cavernosa, there was significant anatomical dysmorphism of the subdermal planes, with an apparent local inflammatory reaction. However, with the Foley urethral catheter for identification and protection of the urethra, and through the connections to the cylinders, the ventral surface of the corpora cavernosa could be identified without major difficulties. After bilateral cavernosotomy, we removed the penile prosthesis cylinders from within the corpora cavernosa. The prosthesis reservoir, which had been positioned through the right external inguinal ring in the space of Retsius, was left in place. We positioned a new reservoir with 125 ml in the space of Retsius by dissection through the left external inguinal ring, which was easily identified and accessed. Conclusions There are few reports in the literature on aesthetic penile filling procedures in patients with IPP. Despite the anatomical alterations, IPP replacement in patients with penile filling was shown to be feasible through the penoscrotal approach. Disclosure No