Abstract Introduction We present a challenging case of distal penile prosthesis erosion in a 66-year-old male with active smoking habit, who underwent multiple prior penile prosthetic surgeries at an outside center. In 2022, he underwent the first implantation of an AMS 700 inflatable prosthesis, which developed a mechanical malfunction after one year. Following this complication, in May 2023, it was replaced with an AMS TACTRA malleable prosthesis. A few months later, in October 2023, he required another intervention to reduce the cylinder size. Finally, in May 2024, the left cylinder was removed due to imminent extrusion. Objective The patient was referred to our center due to imminent extrusion of the right malleable cylinder and requested reconstruction with a three-component inflatable penile prosthesis. Methods This video presents the surgical approach to a complex penile prosthesis replacement in a scarred and surgically altered corporal environment. It details the techniques used for management of fibrosis, and placement of new cylinders, along with the rationale for intraoperative decision-making. Results At the three-month follow-up visit, the patient shows good postoperative evolution. Wounds are well-healed, with no signs of infection or extrusion. At the six-month follow-up, the patient reports full satisfaction with the result and good prosthesis functionality, without complications. Conclusions This case highlights the surgical complexity of reimplantation following multiple failed prostheses, and the importance of individualized planning and patient-centered care in andrological reconstructive surgery. Disclosure No
Grau et al. (2026) studied this question.