BACKGROUND: First-line treatment options for patients with erectile dysfunction whose medical management has failed include the inflatable penile prosthesis (IPP). Many patients with an IPP require subsequent urologic surgery, during which the reservoir of the IPP can be injured.
OBJECTIVE: This review aims to present a summary of current literature related to iatrogenic injuries to the IPP sustained during urologic surgery.
METHODS: Two reviewers independently performed a systematic search on PubMed using standardized search terms to identify pertinent articles. After preliminary review, relevant studies were analyzed to identify the presence of perioperative complications resulting in IPP reservoir injury. Results were categorized by surgical procedures.
RESULTS: Among 13 articles included, all were based on urologic surgery. Four studies identified IPP reservoir injury as a result of surgical injury. Of these, injuries occurred during radical prostatectomy (n = 3) and prostatic urethral lift surgery (UroLift, n = 1). Most radical prostatectomy studies without IPP reservoir injuries also described intentional surgical techniques that were employed to prevent reservoir damage, including modulation of reservoir inflation-deflation (n = 3), temporary reservoir repositioning (n = 1), or reservoir capsule dissection to improve visualization (n = 1). Findings from an additional novel case report on IPP injury during a UroLift procedure are presented in this review.
CONCLUSIONS: Approximately one-third of studies identified intraoperative IPP reservoir injury as a significant complication of urologic surgery, particularly during radical prostatectomy. Novel case report findings also contribute the only other case of IPP reservoir damage sustained from delivery of UroLift implants. Findings are used to create a standardized surgical checklist that guides perioperative planning measures prior to pursuing surgery in adjacent spaces.

BACKGROUND Traditionally, penile implant infections have been treated by removal followed by immediate or delayed replacement. The use of antibiotics in conservative therapy has recently attracted attention. CASE REPORT We report our experience with 4 cases of infected penile implants managed conservatively. Case 1 was a 41-year-old with sickle cell anemia who presented with low-grade fever and purulent discharge that started 1 month postoperatively and lasted for 3 weeks. He had left graft after fibrotic tissue excision with 14-mm collection in the left corpus cavernosum. He was managed with IV pipracillin/tazobactam and vancomycin for 13 days. Follow-up after 23 weeks showed complete wound healing. Case 2 was a 62-year-old with diabetes who had purulent discharge that started 41 days postoperatively and lasted for 1 week. He received 5 days of IV vancomycin and gentamycin. Follow-up after 4 weeks showed marked improvement of the wound. Case 3 was a 61-year-old with diabetes and ischemic heart disease. He presented 30 days postoperatively with fever, purulent discharge for 5 days. He received a total of 10 days of IV vancomycin and gentamycin. Follow-up 3 weeks after discharge showed complete wound healing. Case 4 was a 61-year-old with diabetes and ischemic heart disease. He presented 1 month postoperatively with fever and pus discharge for 1 week. He completed 10 days of IV vancomycin and gentamycin. Follow-up after 1 week showed marked wound healing. CONCLUSIONS Choosing patients with early superficial infected penile prosthesis for conservative management should be tailored to selected patients who does not have leukocytosis, signs of sepsis, high-grade fever, or an exposed device.

Penile prosthesis implantation is a surgical option for erectile dysfunction when other treatments fail or the patient prefers implantation. Although penile prosthesis is generally considered safe and effective, various complications have been reported in the literature. High-flow priapism, resulting from an arteriovenous fistula between the cavernosal artery and the corpora cavernosa, is a rare complication after penile prosthesis implantation. Managing the condition as autoinflation may lead to unfortunate complications. A 54-year-old male patient underwent a penile prosthesis implantation due to erectile dysfunction lasting for 5 years. Doppler ultrasound revealed arterial insufficiency that was refractory to oral and intracavernosal treatments. A 3-piece inflatable penile prosthesis (Coloplast - Titan) was implanted through a midline penoscrotal incision without any complications. The patient reported uncontrolled tumescence after activating the device, which led us to suspect autoinflation. The final diagnosis was high-flow priapism due to an arteriovenous fistula in the cavernosal artery. The patient was given an antiandrogenic medication and the prosthesis was deflated for 3 months. The fistula closed without any additional intervention. High-flow priapism is a rare but potential complication of penile prosthesis implantation. Careful evaluation and management of patients\' symptoms are necessary for diagnosing and treating this condition. This case highlights the importance of considering high-flow priapism as a potential cause of uncontrolled tumescence after penile prosthesis implantation and the possibility of successful non-surgical management.

Injury of iliac vessels is one of the most disastrous complications of penile prosthesis implantation. There are no detailed descriptions of such cases in world literature. In this article, we present the clinical case of injury to the external iliac vein during the implantation of a three-piece penile prosthesis with particular emphasis on the consequences of such complication in the postoperative period. The article comprises a brief review of the literature on the methods of ectopic placement of the penile prosthesis reservoir.

In 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation.
To raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon.
Patient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed.
To identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis.
Four patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found.
If considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications.
The rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients.
Damage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery. Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med 2022;19:879-886.

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis. We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions. The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations. Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function.

Spontaneous rupture of the urinary bladder represents a rare condition that may complicate with paravesical abscess. Although Staphylococcus aureus may be a part of the intestinal tract flora, it is an unusual cause of abdominal or pelvic abscesses. We report the case of a male patient with spontaneous bladder perforation with osteomyelitis and paravesical abscess, secondary to community-acquired methicillin-resistant Staphylococcus aureus infection.

Spinal cord injury patients with indwelling urethral catheters are at high risk for erosion of urethra by penile prosthesis. Repeated misplacement of a Foley catheter with the balloon inflated in the urethra produces additional compression, thus predisposing to erosion of urethra by the prosthesis.
A 22-year male sustained tetraplegia in 1980. He underwent implantation of bladder stimulator, urethral sphincterotomy twice, transurethral resection of bladder neck and then, prostate. In 1991, malleable penile prostheses were implanted to facilitate maintenance of a penile sheath. He required urethral catheter drainage since 1996. The balloon of Foley catheter was misplaced in membranous/bulbar urethra during catheterisations since 2018. In 2020, he developed recurrent penile cellulitis and periurethral abscess resulting in perineal urethro-cutaneous fistula. Cystoscopy showed erosion of urethra at the verumontanum by both prostheses. The prostheses were removed; suprapubic cystostomy was performed.
Inflation of Foley balloon in the urethra for prolonged periods, aggravated by recurrent cellulitis of penis and diabetes mellitus resulted in urethral erosion by the prostheses. Urethral catheterisations in spinal injury patients, who have undergone sphincterotomy, resection of bladder neck/prostate, should be performed by experienced clinicians to prevent complications of catheterisation. Suprapubic cystostomy, performed earlier, could have averted these adverse events.

During the first 5 years after penile prosthesis implantation, complications such as malfunction requiring revision or replacement occur in only 7% of cases. We present a case of a 62-year-old patient who had a Coloplast Titan® prosthesis implanted while also undergoing girth enhancement corporoplasty. Shortly after, the patient noticed an increasing bulge on the side of his penis, which prevented total deflation. An aneurysm of the right cylinder was identified during reoperation; cylinders were replaced and the redundant tunica albuginea and septal defect were corrected by plication from inside the corpora cavernosa.

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the \"Ghattas technique,\" wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.