(V-02) Surgical management of pump malposition in inflatable penile prosthesis using J-shaped repositioning approach

Abstract Background Penile prosthesis implantation remains the gold standard treatment for patients with refractory erectile dysfunction. Although modern surgical techniques and device innovations have improved outcomes, complications such as pump malposition still occur. We present a novel revision strategy employing a J-shaped tubing configuration to stabilize the pump, relieve excess tension, and prevent recurrent migration. Methods We present the case of a patient with an inflatable penile prosthesis (IPP) who developed a mispositioned pump that had migrated superficially against the scrotal wall. Surgical exploration was performed through a longitudinal scrotal incision over the pump. Careful dissection was undertaken to mobilize the pump from the dense adhesions and fibrous tissue capsule that had formed around it. The capsule was completely excised to allow free mobilization of the device and to prevent recurrence of adherence. Because the connecting tubing length was excessive, direct shortening or trimming was avoided to reduce the risk of subsequent leakage or mechanical malfunction. Instead, a novel intra-scrotal repositioning technique was utilized. The redundant tubing was configured in a smooth J-shaped loop within the dependent portion of the scrotum, thereby relieving traction forces and preventing kinking. At the corner of the J-loop, the tubing was secured with a 2-0 PDS suture to maintain the configuration and stability. The pump itself was then anchored in an anatomically dependent and accessible position, ensuring both patient comfort and ease of manipulation. Hemostasis was achieved, and the incision was closed in layers in the standard fashion. Results The procedure was completed without intraoperative complications. Postoperatively, the patient had no wound-related complications. Early activation testing demonstrated smooth pump function, with effortless inflation and deflation. At follow-up, the patient reported marked improvement in ease of use and was able to cycle the device independently without difficulty. No recurrence of malposition, pump migration, or signs of impending erosion were observed during the follow-up period. Conclusion This case highlights the importance of timely surgical revision in patients with mispositioned IPP pumps to avoid progression to scrotal erosion and potential device loss. By excising the fibrous capsule and employing a novel J-shaped repositioning technique, the pump was stabilized in a functional position without compromising tubing integrity. This approach represents a simple, safe, and effective option for managing complex pump malposition, and may be particularly useful for surgeons encountering similar revision challenges in prosthetic urology.