Abstract Introduction Distal cylinder migration or impending erosion remains a vexing challenge after inflatable penile prosthesis (IPP) implantation, particularly in revision and reconstructive settings with scarred or thinned distal corpora. We report outcomes of a novel glans tunneling fixation technique developed to enhance distal stability and preserve cosmesis, including its first successful application in a reconstructed neophallus following oncologic penectomy. Objective To describe a novel glans tunneling fixation technique for managing distal cylinder migration or impending erosion following inflatable penile prosthesis (IPP) implantation and to evaluate its feasibility, safety, and applicability in both complex revisions and reconstructed phallus cases. Methods Five men (mean age 54.8 years; range 20–70) underwent IPP revision using the glans tunneling fixation technique between 2021–2025. Following subcoronal exposure and corporoplasty, the distal tunica was internally reinforced with Tutoplast graft. A Keith needle was used to tunnel the distal fixation sutures transversely across the glans, exiting through a single glanular site; the sutures were tied together and buried subdermally to provide cross-anchoring. One patient had a history of epithelioid sarcoma treated with partial penectomy and radial forearm free-flap phalloplasty prior to prosthesis implantation. Outcomes included procedural safety, cylinder stability, postoperative sexual function (SHIM), and patient satisfaction. Results No intra- or postoperative complications occurred. All five cylinders remained stably positioned at follow-up (2 weeks–6 months) with no infection, sensory change, or re-erosion. Four of five patients resumed sexual activity. The Mean postoperative SHIM = 22.1 (range 21–23). The reconstructed-phallus case showed excellent perfusion confirmed by intraoperative ICG and complete prosthesis integration without ischemic compromise. All patients reported high cosmetic satisfaction and absence of glanular pain. Conclusions This novel glans tunneling fixation technique provides a simple, reproducible, and biomechanically stable method for distal cylinder fixation. Its successful adaptation to a reconstructed neophallus broadens applicability to complex prosthetic and reconstructive cases. Early outcomes are encouraging, warranting multicenter validation and long-term follow-up. Disclosure No
Oscar et al. (Mon,) studied this question.
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