(004) Augmentation With Macroporous Polypropylene Mesh as a Salvage Maneuver for Tunica Defects in IPP Revision Surgery with Accidental Tunica Perforation and Severe Fibrosis

Abstract Introduction Inflatable penile prosthesis (IPP) re-implantation surgery following a previous IPP explantation is very challenging due to severe fibrosis and penile shortening, both in length and width. It becomes even more difficult in the presence of abandoned IPP components, such as rear-tip extenders, as their retrieval may be tricky and in cases of accidental corpora perforation with significant tunica defects. Surgical Mesh has been used for years in penile implant surgery to reinforce, reconstruct, or completely replace segments of the penile shaft in cases of prosthesis protrusion or excessive corporal fibrosis with inadequate corpora width to accommodate a narrow base implant. However, the mesh has always been fashioned as a windsock over the penile prosthesis to ensure implant stabilization. Objective Given the reported complications of this windsock technique, including device infection, pain, and erosion, we developed a novel reconstruction technique for augmenting narrow corpora caverns or covering tunical defects, which requires a significantly smaller portion of mesh material. The Mesh is sutured to the intact surrounding tunica tissue with non-resorbable sutures just to fill the corporal defect. This promotes tissue ingrowth into the defect and stabilizes the implant, while minimizing the use of unnecessary mesh material in the medial, uninjured sections of the corpora cavernosa, thus reducing the risks mentioned above. Methods A re-implantation surgery 7 years following IPP explantation with an abandoned rear-tip extender was performed via penoscrotal approach, which was challenging due to severe fibrosis, especially on the left corpus cavernosum. The abandoned rear-tip extender was retrieved via additional proximal corporotomy as its retrieval through the initial corporotomy failed. An accidental distal tunica perforation occurred during dilatation due to the narrow fibrotic corpus cavernosum, which was salvaged by using an appropriately tailored macroporous polypropylene mesh. Results Surgical time was 122 minutes. The drain was left in place for 2 days. The IPP was left partially inflated for 2 days and activated uneventfully at 6 weeks. The postoperative period was unremarkable. The patient has been sexually active without complications after 6 months of follow-up. Conclusions In conclusion, surgical mesh may be considered alongside biological allografts as salvage material to repair defects in the tunica albuginea of the corpora cavernosa, accompanying penile prosthesis implantations. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston scientific