(358) Repair of Aneurysms and Lateral Failures of the Albuginea with an Original Double Breast Technique

Introduction Structural failures of the tunica albuginea include apical and lateral wall failures, the latter being associated or not with aneurysms of the prosthetic cylinder; this condition causes loss of stability and axial rigidity of the penis (“wobbly effect”) and deformity. Surgical correction requires reshaping of the corpora, eventually with reinforcements of the tunica and, in the presence of cylinder aneurysm, replacement of the implant. Objective Double breast technique is a smart solution to reinforce the tunica, but it might be not easy to perform precisely. We present a simple and effective technique to reshape the corpus cavernosum and create a double-breast reinforcement of the albuginea. Methods Case presentation 55 year old patient, in 2010 three-pieces prosthesis implantation (AMS 700 CX) plus widening bilateral corporoplasty with intexen grafts for a severe fibrosis due to ischemic priapism. In 2012 apicoplasty with polypropylene mesh pads for bilateral apical failure. From 2023 progressive bulging of penile shaft at the proximal third with wobbly effect and inability to penetrate. The MRI shows a huge aneurysm of both the corpora cavernosa. Surgical technique Penoscrotal access. After removal of the old implant, a plication of excess albuginea is obtained with two Allis pliers to reshape the corpus cavernosum over the guide of a 13 mm Hegar dilator; the plication is stabilized by U shaped two zeros absorbable stitches placed at the base of the fold. Allis pliers are then removed and if the reshaping results correct, section of the medial layer only of the fold, taking care to keep the lateral layer continous with the wall of the corpus cavernosum. This step is essential to create a bloody margin of the tunica albuginea which will lead to definitive healing of the corporoplasty, and at the same time to sculpt a flap with the excess albuginea. The flap is then developed medially to duplicate the tunica albuginea and fixed with absorbable stitches like a double breast suit. The same procedure is performed on both sides; then a new three-pieces implant is placed. Case series We performed this technique in 4 cases, 3 with prosthetic aneurysms, one with a huge herniation of an oversized implant. All patients were recalled and underwent clinical office evaluation and EHS scoring in October 2025 (Follow-up range: 5-12 months) Results No complication were observed in our initial series; in all the cases the shaft regained an uniform girth and the patients resumed satisfying sexual activity within 2 months. The EHS score at follow up was 4 for all the patients and the double breast and the stitches were not palpable. No relapses of the failure have been recorded so far. Conclusions Our technique allows to perform easily, quickly and precisely the reshaping of the corpus cavernosum with a double breast reinforcement of the tunica albuginea. This surgical solution is useful in every patient presenting with lateral wall failure of the tunica with or without deformation of the cylinder. Disclosure No