Reimplantation of inflatable penile prosthesis into scarred corporeal bodies

Reimplantation of an inflatable three-piece prosthesis in a patient with severe corporeal fibrosis represents a formidable surgical challenge. In the past, a variety of techniques have been offered to facilitate implantation in these difficult patients including the use of instruments to produce a channel in which cylinders can be placed and choosing multiple surgical sites, including the use of surgical sites that have not previously been used. The author of this communication describes newer tools and techniques to enhance placement of an inflatable device in patients with severe fibrosis. This includes the use of specially designed cavernotomes for dilating fibrotic corpora, the use of downsized prosthetic cylinders, alternative procedures to fix cylinders in the face of perforation as opposed to primary closure of the perforation, and replacing the original cylinders after 1 y after the modified cylinders have served as tissue expanders. Details of these newer techniques are presented by an experienced surgeon.