Corporal excavation and penile prosthesis placement for severe corporal fibrosis

The penile prosthesis has significantly improved the lives of men with erectile dysfunction refractory to vacuum, medical, or injection therapies and has become the standard of care in this patient population. While device placement in the setting of virgin, physiologically normal tissue can be straightforward, prosthesis implantation in the presence of corporal fibrosis presents a unique challenge to even the most experienced implanter. Over the years, many different surgical tools and techniques have been utilized in these patients including corporal excavation, scar tissue resection, extended corporotomies, cavernotomes, and grafts for corporal reconstruction. Here we present our unique surgical approach for penile prosthesis implantation in a patient with severe corporal fibrosis. His pathology resulted from two episodes of prolonged priapism, two distal shunts, as well an aborted three-piece inflatable penile prosthesis placement complicated by a wound infection.