Abstract Introduction We present the case of a 41 male patient in need of a penile prosthesis implant as he does not respond to any other treatment. He has been experiencing through out the last 10 years a progressive loss of response to oral and topical medication. Thus implant seems the goal standard treatment to offer him. Objective To show the importance of accuratte diagnosis preivous to implant surgery to optimize patient satysfaction and avoid intra and postoperative complications complication To show the importance of understanding the penis anatomy and why this patient has progressivley lost response to other treatments that initially worked. Methods Patient underwent rutinary diagnostic protocol at our center and high definition doppler dynamic ultrasound of the penis was performed with expert sonographer (over 30 years of experience). Images and report where discussed with him thouruly and action plan for surgery was agreed. Patient finally underwent surgery at another center. Results Patient was diagnosed of an arterial insuficiency whish was already producing harder tissue in the distal part of the corpora cavernosa and as a result he already had fibrotic tissue in the corpora cavernosa covered bny the glans. This expleains the progressive loss of response to other medical treatments. All this was pointed out to the patient and finally the patient decided to perform surgery with another surgeon that did not do ultrasound and did not have in account the report and images that where haneded in to the patient. After 1 week surgery patient could notice implant where short and that they where not reaching the distal part of both corpora cavernosa thus creating a "floppy glans" siatutation. After a new ultrasound together with dynamic 3d MRI to prove the situation, redo surgery performed to implant accurrate cylinders once distal dilatation was performed correctly. Cylinders implanted where 2 cms bigger than the original ones. Conclusions In penile implant surgery having an accurrate diagnosis of the structure of the penis is crutial to be able to prepare the surgery and accomplish the implantation for an optimum result. Initial surgeon thought that he had reached both corpora cavernosa distally because the fibrotic tissue whcih was initially seen in the 1st ultrasound seem to be the limit. Only of previous klodge of the global penile situation is gathered these situations may be avoided resulting in ultimate satysfaction of both patient and surgeon. Disclosure No
Gayá et al. (Mon,) studied this question.
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