Strategy for Salvaging the Shrinking, Soft Glans Penis and Impending Prosthesis Loss in Patients with Penile...

Shrinking, soft glans penis is contemporarily unavoidable in patients with penile implantation, the final solution to intractable erectile dysfunction (ED). This condition poses a challenge in primary impotence.

We present a case of a 43-year-old patient with primary impotence who underwent six penile prosthesis procedures, alternating between inflatable and malleable prostheses. His sixth implantation involving a malleable cylinder enabled him to engage in dozens of intercourse episodes between the ages of 42 and 43 years. However, this action led to an impending prosthesis extrusion. The patient reported that his partner had firstly raised concerns regarding his shrinking, soft glans. Although prosthesis extrusion is avoidable and soft glans is treatable, persistent surgeon ignorance has led to missed management opportunities. Anatomical understanding is crucial for surgical success. Therefore, we present this unusual case to highlight strategies for treating soft glans in patients with penile implantation.

Although the proactive implementation of preventive measures against prosthesis extrusion was firstly recommended 3 decades ago and a novel strategy for glans enhancement was introduced a decade ago, inadvertent ignorance persists in modern surgical practice. In this case study, we highlight the importance of proper cylinder positioning and the need for innovative glans enhancement techniques.