Abstract Introduction Penile implants are goal standard treatment for E.D. when all other treatments fail. It is important to have a clear picture of the penile anatomy prior to the surgery to avoid intraoperative complications that normally lead to uncorrectly implanted devices thus resulting in both patient and surgeon dissatisfaction. Objective Revision surgery of penile prosthesis implant that was not functioning and patient was unhappy and with pain, in the infrapubic region, scrotal area and distal part of his shaft. Methods Patient implanted in october 2023 who is unable to activate the implant due to the location of the pump system and also experiences pain at the distal end of the penis as well as discomfort during daily activities due to the positioning of the reservoir. MRI and dynamic high definition ultrasound where performed to identify all the implant parts and prepare surgical plan. Results MRI was only perforemed in flacid state: (by original implanter) we performed dynamic high definition ultrasound and found: incorrect positioning of reservoir in the infrapubnic region incorrecto positioning of pump in the penoscrotal angle: thus resulting in maserrati tubes and uncomfortness for patient devide was not functiong over 6 months of no pumping left cylinder was 3 cms away from the distal part of the lect corpora cavernosa devide was a 22cms cylinder with 2 cms rte and a 75 cc reservoir situation expleaned to patient and re do surgery planned, prepared to relocate all devide parts, although mayor cylinder rechange was also planned. 4-hour surgery summarized in less than 4 minutes with photographs of the late postoperative period and follow-up. Together with the ultrasound images. This patient need a infrapubic incision for reservoir localisation a scrotal incision for pump and cylinder explantation, twisted left cylinder found. Subcoronal left incision to be able to use rossello cavernotomes strongly to work our way trhough fibrotic tissue to end up implanting a 24 cylinder lenth together with a 125 cc reservoir in the right paravesical area. Conclusions Obtaining a correct diagnosis through mri and dynamic ultrasound is key to properly visualizing cases before entering the operating room. Before this, in virgin patients, considering imaging studies when there are doubts about the condition of the tissues is essential to avoid these situations. Disclosure No
Gayá et al. (Mon,) studied this question.