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Introduction:Corporal fibrosis can make the insertion of a penile prosthesis very challenging. Various Methods have been described regarding dilation of the fibrotic corpora. We describe our experience using cavernotomes, sharp corporal excision, or both techniques in conjunction. Our study investigates outcomes and complications of penile prosthesis placement in patients with corporal fibrosis.
Materials & Methods:This is a retrospective study of 20 patients with erectile dysfunction significant corporal fibrosis. Over an 8-year period, these patients underwent insertion of penile prosthesis. Most patients required use of cavernotomes and/or sharp corporal excision for corporal dilation. Charts were reviewed for cause of fibrosis, use of advanced measures of dilation, and outcomes after surgery.
Results: Corporal fibrosis was due to previously infected prosthesis in 8 patients, priapism in 9 patients, extrusion of prior prosthesis in 2 patients, and Peyronie's disease in one patient. During placement of penile prosthesis, cavernotomes were used in 8 patients, sharp corporal excision in 3 patients, and combination of sharp corporal excision and cavernotomes in 2 patients. Penile prosthesis was successfully placed in all 20 patients. Overall, 16 patients (80%) have had no complications to date. Complications included infection in 2 patients, urethral erosion in one patient, and malpositioned prosthesis in another patient. Interestingly, there were no complications in patients who had fibrosis secondary to priapism.
Conclusions:Penile prostheses can safely be placed in patients with significant corporal fibrosis, especially in patients with history of priapism. If dilation is challenging, cavernotomes and sharp corporal excision can be used safely.