This document summarizes complications that can occur with penile prosthesis surgery, including intraoperative and postoperative complications. Intraoperative complications include perforation of the tunica albuginea or urethra, cavernosal crossover, and reservoir problems. Postoperative complications involve dissatisfaction due to pain, numbness or diminished sensation, as well as surgical complications like infection, mechanical failure, erosion or extrusion of the device. Management strategies are discussed for repairing injuries or replacing problematic or infected devices. In summary, this document outlines potential risks and approaches to addressing complications from penile prosthesis implantation.

1. COMPLICATIONS OF PENILE
PROSTHESES
By
Hassaan Ali Gad
Assistant lecturer of urology
Aswan University
hassaan.ali@aswu.edu.eg
2017

2.  INTRAOPERATIVE COMPLICATIONS
 POSTOPERATIVE COMPLICATIONS
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3. INTRA-OPERATIVE COMPLICATIONS
 Perforation of the tunica albuginea
- Distal
- proximal
 Urethral perforation
 Crossover
 Unexpected fibrosis
- distal: priapism,
- proximal:secondary implant after infection
 Reservoir –problems
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4. PERFORATION OF THE TUNICA ALBUGINEA
PROXIMAL PERFORATION
 It is recognized when there is a sudden loss of
resistance to the passage of the dilator.
 MANAGEMENT: without Urethral injury
 The dilation should be completed contralaterally to
show the true length of the crus and, later, return to
the damaged crus to complete the dilation using
large dilators .
Before placing the cylinder, a Dacron sock can be
placed at the distal tip of the prosthesis and sutured
to the distal tunica albuginea.
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6. PERFORATION OF THE TUNICA ALBUGINEA
DISTAL PERFORATION
 It is result from vigorous dilation in cases of corporal fibrosis.
 MANAGEMENT: without Urethral injury
 perforation is at the distal tip of the corpus cavernosum: it
can be repaired by elevating the glans off the corporal body
through a dorsolateral semi-circumferential incision. Then
tunical defect closed with a2-0 synthetic absorbable suture.
 perforation is on the lateral aspect of the corporal body,a
repair can be made through a semi-circumferential incision
directly over the perforation without mobilizing the glans
 a patch can be sewn over the repair for additional strength to
prevent later extrusion.
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7. URETHRAL PERFORATION
 Proximal urethral injury
 At initial corporal dissection :the urethra should be
repaired in multiple layers ,and implant should be
delayed eight weeks.
 After corpora have been opened,
following suggestions according surgeon preference
and experience.
 Patient is at higher risk: the urethra should be repaired
and placement of the device should be delayed.
 In a non–high-risk patient: : the urethra should be
repaired and placement of the device, A suprapubic and
uretheral catheter should be placed for 2ws.
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8. URETHRAL PERFORATION CONTINUE
 Distal urethral perforation:
 the most common urethral injury is the dilator
protruding through the meatus.
 Urethral repair or suprapubic diversion is not
necessary just catheter placement for two weeks.
 Prosthesis placement should be delayed for at least
eight weeks until retrograde urethrogram
demonstrates complete urethral healing.
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9. CAVERNOSAL CROSSOVER
 A crural crossover should be suspected if the
dilating instrument deviates from the expected path
 MANAGEMENT: without Urethral injury
 Dilation of the contralateral corpus,then a dilator
should remain in this contralateral side while
dilation is resumed on the side of the crossover.
 the first prosthesis cylinder is placed on the side of
the perforation while the dilator is still in place on
the contralateral side.
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10. POSTOPERATIVE COMPLICATIONS
 Penile implant is not adequately mimic a normal
physiologic erection.
 Satisfaction rates of 70-87% are reported from
patients after appropriate consultation.
 DISSATISFACTION
 chronic penile pain 0.26% to 11%,
 numbness 0.2% to 2.5%,
 diminished quality of orgasm,
 suboptimal penile length 0.9 cm less,
 sensation of a cold penis,
 sensation of unnatural intercourse,
 dyspareunia.
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11. SURGICAL COMPLICATION
Minor complications :
 wound haematomas and superficial
wound infections that can be resolved
using antibiotic therapy.
Major complications :
 prosthesis infection
 mechanical failure
 protrusion, erosion
 Penile deformity
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12. SURGICAL COMPLICATION CONTINUE
 INFECTIONS :can occur with both semi- rigid and
inflatable prostheses although the risk of infection
has decreased since the introduction of antibiotic-
coated implants .
 To avoid it:
-Delay implantation if UTI or cutaneous infections
-Shave day of surgery
-10 minute skin prep
-Gent -vancomycin
 Role of diabetes is controversial as related to
infection probability
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13. SURGICAL COMPLICATION CONTINUE
 EARLY INFECTIONS 1st few weeks - gram negative
Swelling, erythema, tenderness, drainage
 LATE INFECTIONSA fter 6 months – gram positive by
(Staphylococcus epidermidis and S. aureus).
Skin may be adherent to pump
Erosion is evidence of infection
 Management: complete removal then
 1- Washing of the corpora cavernosa with an
antibiotic solution, then place a cylinder inside the
corpora cavernosa to prevent shortening and the
development of internal scarring of the penis
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14. SURGICAL COMPLICATION CONTINUE
 2-use of the Mulcahy salvage procedure to reinsert a new penile
prosthesis in the same sitting
Mulcahy salvage protocol
1-Antibiotics (kanamycin–bacitracin)
2-Half-strength hydrogen peroxide
3-Half-strength povidone iodine
4-Pressure irrigation (water pic) with 1 gram vancomycin and 80
grams gentamicin in the 5 litres of irrigating solution
5-Half-strength betadine
6-Half-strength hydrogen peroxide
7-Antibiotics (kanamycin–bacitracin)
 3-Eradication of implant’ infections being achieved by the use of
systemic antibiotics alone, without the removal of the implants
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15. MECHANICAL FAILURE
 Mechanical failure can occur with both semi- rigid and
inflatable (two- and three-compo- nent) prostheses.
 Inflatable implants, causes of failure can be leakage
from the cylinder, reservoir or tubing, an aneurysm in the
cylinder or damage to the tubes
 Semirigid implants, mechanical failures are frequently
caused by rod fracture.
 In the past, in cases of mechanical problems in an
inflatable prosthesis the trend was to remove only the
damaged part (pump, reservoir, cylinder, tubes), but
recently the more common management option is to
remove and replace, in the same sitting, the all
prosthetic device.
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16. CYLINDER EROSION/EXTRUSION
 Oversized cylinders cause pain and can erode
 If a cylinder erodes medially, the patient will more
likely have dysuria and hematuria or will see the
device protruding through the meatus
 Proximal erosion of a cylinder will result in
asymmetry or a corporoglanular deformity
 it is necessary to remove the entire prosthetic
device and to replace the implant in the same
sitting.
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18. PENILE DEFORMITY
 SUPERSONIC TRANSPORT (SST), Glans –
concorde syndrome’’
 This condition occurs after implant of an undersized
cylinder .
 It results in a ‘‘floppy and hyper- mobile glans’’
 MANAGEMENT
 dissection of the glans from the underlying tissue
using a subcoronal incision, followed by fixation of
the glans to the tips of the corpora cavernosa.
 Cylinder removal is not necessary
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20. THE ‘‘S-SHAPED’’ DEFORMITY OF THE
PENIS
 It is a complication occurs if uncompleted distal
dilation of the corpora cavernosa and/ or inserted
too short cylinders
 MANAGEMENT
 the device removed,
 the distal part of the corpora cavernosa should be
inflated
 the replacement prosthesis whithlonger cylinders
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22. „ The first implant
is
the best implant“
Thank you for your attention
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