Abstract Introduction Cylinder crossover, where a penile prosthesis cylinder traverses the intercavernosal septum into the contralateral corpus, is a rare but function-limiting complication. It causes pain, asymmetry, and mechanical dysfunction. We report a revision case and outline stepwise surgical management and prevention checkpoints. Objective The objective was to establish a series of diagnostic steps and check-points during revision surgery to manage crossover of penile prosthesis implant. Methods Case presentation: a 62 years old man with prior radical cystectomy (pT3b + CIS, N0 R0) and orthotopic neobladder (March 2022) underwent inflatable penile prosthesis (IPP) implantation (Rigicon Infla©, September 2024). He developed penile pain right after the surgery and difficulty using the IPP for 6 months. Pre-revision evaluation supported cylinder crossover; pelvic MRI was considered to refine the differential (malposition vs fibrosis vs reservoir–tubing issues). Results At clinical inspection, the tip of the right cylinder was identifiable at a glandular level, while the tip of the left cylinder was pushed at sub-coronal level. After penoscrotal incision, a careful dissection was performed to identify device components. The perforated septum allowed the right cylinder access to the left corpus cavernosum. A device check (inflation/deflation) was performed to assess function and presence of potential leak. The IPP worked perfectly and the length of the cylinders was correct, so a conservative approach was preferred. The surgeon then proceeded to the closure of the inter-cavernosa septum with interrupted absorbable sutures to eliminate intercorporal communication and bilateral re-tunnelling of the corpora cavernosa underneath the pseudocapsula. A new proximal and distal symmetric dilatation with Hegar dilators was performed, staying strictly within each corporal body to recreate the correct tracts. An antibiotic and iodine wash of the cavities and the cylinders was done to reduce the risk of infection. Operative time was 85 minutes. No intra-operative or post-operative complication happened. Sexual intercourse was possible 6 weeks after surgery. Conclusions Cylinder crossover is uncommon but remediable. A structured approach-re-tunnelling with meticulous bilateral symmetry and formal septal closure, coupled with selective component exchange-can restore function and relieve pain while preserving the device when feasible. Standardised intraoperative checkpoints and preoperative MRI improve diagnostic confidence, reduce recurrence, and streamline decision-making in complex IPP revisions. Disclosure No
Falcone et al. (2026) studied this question.