Management of distal extrusion of penile prosthesis: partial disassembly and tip reinforcement by double breasting or grafting.

INTRODUCTION Distal erosion and perforation of penile prosthesis have been reported in association with neurologic impairment, diabetes mellitus, and following irradiation for prostatic cancer. Once perforation occurs, reimplantation carries a higher risk of reperforation unless adequate preventive measures are taken. Aim. This is a description of a procedure whereby the point of perforation was exposed and repaired to restore distal support. METHODS In three patients with distal extrusion of penile prosthesis through the urethra, the glans was mobilized off the tip of the corpus cavernosum and the caverno-urethral fistula was disconnected from the corpus cavernosum. The fistula was sealed by primary sutures. The perforation on the corpus cavernosum side was sealed by double breasting in two cases and by grafting in one case. Prosthesis was reimplanted. MAIN OUTCOME MEASURES Complications, recurrence of erosion, and postoperative coital pain. RESULTS No complications, recurrence, or persistent pain occurred in any of the three cases. CONCLUSION The management of the distal extrusion of penile prosthesis by partial disassembly, double breasting, or grafting may provide reliable distal support and thereby avoid reperforation and repeated extrusion.