Distal Extrusion and Impending Cylinder Erosion of the Penile Prosthesis: a Clinical Challenge for the Urologist

Distal extrusion with impending cylinder erosion through the distal corpus cavernosum is a significant complication of penile prosthesis surgery. Surgical repair is indicated to prevent cylinder perforation or erosion through the skin, which leads to infection and requires removal of all prosthesis components. The underlying cause is typically unrecognized tunical perforation during surgery, aggressive distal dilation, oversized cylinders, or repeated trauma. Extrusion is more common in patients with microangiopathy, prior radiation, corporal fibrosis, or decreased distal sensation. The two most prevalent methods for repair are distal corporoplasty or windsock graft reconstruction. Distal corporoplasty has been demonstrated to have superior outcomes to windsock grafts and is the method of repair that these authors favor. The goal of this review is to provide a background on distal penile prosthesis extrusion, along with potential treatment approaches, so that the surgeon may be familiar with this seemingly difficult, albeit rare, complication of penile prosthesis surgery.