Abstract Introduction Peyronie’s disease is a fibrotic disorder of the tunica albuginea that leads to penile curvature, deformity, and often erectile dysfunction. Surgical correction is indicated in stable disease and can be performed through plication corporoplasty, grafting techniques, or penile prosthesis implantation in patients with concomitant erectile dysfunction. In complex or recurrent cases, mesh materials may be used to reinforce the tunica or repair corporal defects; however, their use can sometimes lead to complications during subsequent revision surgeries. Objective To demonstrate the surgical management of a complex revision case following multiple penile prosthesis failures and extrusions. Methods This is the case of a 64-year-old male with hypertension and dyslipidemia under treatment. The patient was diagnosed with Peyronie’s disease in 2012, presenting with a ventral curvature. In 2020, he underwent corporoplasty with a porcine dermal graft. A malleable penile prosthesis was implanted in 2021 through an infrapubic approach. In 2022, proximal migration of the cylinders occurred, requiring removal of the device. In 2024, new malleable cylinders were placed; however, postoperative urethral extrusion led to explantation. In January 2025, a new implantation attempt resulted in urethral injury when placing the right cylinder, allowing placement of the left cylinder only. Preoperative magnetic resonance imaging (MRI) revealed improper positioning of the single implanted cylinder within the left corpus cavernosum, as well as the presence of unidentified material in both corpora cavernosa, underscoring the need for surgical revision. Results A longitudinal incision was performed, followed by lateral mobilization of the urethra. The left corpus cavernosum was identified, and a cavernotomy was made, which proved challenging due to fibrosis. The previously implanted cylinder and distal extender were removed. Mesh from a prior procedure was unexpectedly found, correlating with the unknown material observed on MRI. Rerouting and dilation of the left corpus cavernosum were performed, although distal dilation was difficult due to severe fibrosis; double-action Metzenbaum scissors were used to facilitate dilation. The right corpus cavernosum was then located, and a cavernotomy performed, also challenging due to fibrosis and residual mesh. Dilation was particularly difficult, requiring the use of a Rosselló cavernotome. Symmetry between both corpora was confirmed, intraoperative measurements were obtained, and a 12+1 three-component penile prosthesis was implanted. The reservoir was placed in the right paravesical space. A scrotal drain was positioned and subsequently removed before discharge. The patient was discharged the following day, with an uneventful postoperative course except for minimal wound dehiscence, managed conservatively. Conclusions Postoperative computed tomography demonstrated both cylinders to be well positioned and symmetrical. The final outcome was satisfactory in terms of both cosmetic appearance and functional result. This case illustrates the dual role of mesh in penile prosthesis surgery: potentially beneficial for structural support yet capable of complicating future revisions, emphasizing the need for careful patient selection and meticulous surgical technique. Disclosure No
Sureda et al. (Mon,) studied this question.