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Penile prosthesis placement in patients with corporal fibrosis secondary to infection or priapism: Outcomes and complications
Priyanka Bearelly, MD, MPH1, Shu Pan, MD2, Dayron Rodriguez, MD, MPH3, Michael Rezaee, MD4, Michael Witthaus, MD5, Nannan Thirumavalavan, MD6, Kevin Krughoff, MD4, Martin Gross, MD4, Ricardo Munarriz, MD1.
1Boston University, Boston, MA, 2NorCal Urology, Walnut Creek, CA, 3UT Southwestern Medical Center, Dallas, TX, 4Dartmouth-Hitchcock Medical Center, Lebanon, NH, 5University of Rochester, Rochester, NY, 6Case Western Reserve University, Cleveland, OH.

Introduction Corporal fibrosis can make the insertion of a penile prosthesis very challenging and is associated with high complication rates. Common causes of this pathology include prior infection, history of priapism, radiation therapy, poorly controlled diabetes, Peyronie's disease, etc. Dilation of the corpora both distally and proximally often require the use of cavernotomes, Rarely, sharp corporal excision may be necessary if the corporal fibrosis is severe. Objective The aim of this study was to investigate the outcomes and complications of penile prosthesis placement in patients with corporal fibrosis.Methods This is a single institution retrospective IRB approved study of 34 patients (mean age 52 years, range 31-74 years), with corporal fibrosis who underwent placement of penile prosthesis during a 16-year period. Results Etiologies of fibrosis included history of penile prosthesis infection (41.2%, 14/34), priapism (41.2%, 14/34), erosion of penile implant requiring explant (11.8%, 4/34), and poorly controlled diabetes (5.9%, 2/34). With regards to surgical techniques, sharp corporal excision was utilized in 5 patients (14.7%), cavernotomes in 7 patients (20.6%), and a combination of both sharp excision and cavernotomes in 17 patients (50%). In 5 patients (14.7%) where fibrosis was notable, the surgeons were able to dilate the corpora without the aforementioned specialized techniques, although more difficult. Complications included malpositioned prosthesis (8.8%, 3/34), distal erosion (2.9%, 1/34) and infection (2.9%, 1/34).Conclusions Penile prostheses can safely be placed in patients with severe corporal fibrosis. However, surgeons must be prepared to use cavernotomes or sharp corporal excision in order to effectively dilate the corpora.


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