PMC8318022_01
A and B. Pre-operative photos revealing ventral penile curvature, penile bulge and evident scrotal pump.
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October 2019, 4 years after the initial surgery, the patient presented to the Sava Perovic Foundation seeking a solution. On physical examination, a ventral curvature induced by the semi-inflated prosthesis was evident, with a clear bulge on the right side of the penis (Figure 1A). The high-riding pump was visible and substantially elevated the penoscrotal angle, giving an appearance of a shorter penis (Figure 1B).
A. Right cylinder aneurysm; B. Septal defect showing communication between both right and left side; C. Redundant tunica marked with a pen for excision; D. Tunical closure with 6-0 polydioxanone sutures (PDS).
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A 6 cm aneurysm of the right cylinder was evident upon removal (Figure 2A). A longitudinal ventral corporotomy exposed the thinned and redundant tunica albuginea of the right corpora, revealing extensive septal rupture with communication between the right and left capsules created by the cylinders (Figure 2B). Correction was ensued, first by removing part of the redundant tunica albuginea from inside the capsule (marked with a pen, as seen in Figure 2C) and closing this defect (Figure 2D) with a running suture using 6-0 polydioxanone sutures (PDS), cautiously as not to injure the overlaying neurovascular bundle.
A and B. Right metal dilator inserted in tunical defect before closure; C. New Coloplast Titan  prosthesis before insertion; D. Final result.
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A metal dilator was inserted in the corpora and the albuginea was sutured internally (Figures 3A and 3B). The new prosthesis (Coloplast Titan  of 20 cm with a 2 cm rear tip extender) was inserted using the standard technique with a mesh 'sock' covering the distal tip of the right cylinder to prevent further erosion of the glans, as seen in Figure 3C. After prosthesis placement, a suprapubic 'Y' incision was made to correct the previous scar and to reconstruct the penile suspensory ligaments (Figure 3D).