(154) Corporal Tissue Ingrowth: A Rare but Operable Challenge in Revision Surgery for Inflatable Penile Prosthesis

Abstract

Corporal tissue ingrowth into previously implanted cylinder is a rare but possible issue encountered during penile prosthesis (PP) revision surgery. To prevent cylinder aneurysms, a middle layer of woven and expandable polypropylene-like material was incorporated into the implant design in 1987. While the outer silicone layer usually prevents its contact with tissue, in cases of ruptured cylinders, there is a risk of cavernous ingrowth into the exposed woven layer. Collagen deposition within the inflammatory tongue of tissue can lead to significant difficulty in implant removal. Having a degree of suspicion about this phenomenon is important, especially as an implant may remain somewhat functional if the inner silicone layer remains intact. If encountered, its recognition is paramount in triggering operative countermeasures. To our knowledge, this is the only contemporary and second case series describing this phenomenon in English literature. To highlight the existence of this difficult phenomenon in revision surgery and demonstrate our approach. We report 3 patients over the past 3 years who underwent complex penile revision surgery. All had AMS penile implantation 10–15 years prior and presented with inability to inflate device. Each case began routinely through a vertical penoscrotal incision; however, the stuck cylinders were unable to be removed through the traditional corporotomy. Penoscrotal incision and corporotomy were extended until the location of ingrowth was identified. A combination of sharp and blunt dissection was required to liberate the cylinder from the surrounding corporal tissue. Care was taken to maintain a plane just outside the ruptured cylinder to prevent more proximal or distal injury to the tunica albuginea. Once liberated and new device implanted, corpora are closed in the usual fashion without the need for elaborate tunica albuginea reconstruction. All 3 patients had successful revision of impacted cylinder from the corpora through extension of the vertical penoscrotal incision. No secondary distal incision was necessary in these cases. Patients were followed for 6–12 months in which time all prosthesis remained functional and no deviation from the usual post-operative course was encountered. Implanters should not shy away from maximizing exposure if ingrowth is suspected. The vertical penoscrotal incision was a versatile approach that could be easily extended and should be considered for suspected complex revision surgery. Furthermore, this phenomenon also adds credence to early revision surgery in the cases of device malfunction from suspected cylinder rupture. Despite the difficulty this issue poses, corporal tissue readily integrates into porous synthetic materials. This ability may be useful in future device development in the tissue engineering space. No.