Editing Penile Prosthesis (section)

=== Intraoperative ===
*'''<span style="color:#ff0000">Organ injury/perforation, cylinder crossover, and damage to the device during implantation'''

==== Corpora cavernosa perforation ====
* To prevent distal or proximal crossover into the contralateral corpus during initial dilation, constant traction should be applied to the shaft of the penis by pulling on the glans, and the curvature of the scissors should be maintained away from the midline of the penis, with the tips next to the tunica albuginea.
*'''If crossover occurs, it is usually preferable to recognize it and correct it when recognized, rather than after further dilation or insertion of the cylinders.'''
* '''Most likely location for perforation is at the septum'''
* '''<span style="color:#ff0000">Distal perforation'''
** '''Evaluated by exposing the damaged corpus apex through a transverse incision of the skin and tunica albuginea near the glans'''
** '''<span style="color:#ff0000">Management'''
*** '''<span style="color:#ff0000">A small hole can usually be</span>''' located distally on the medial aspect of the cavernosal cavity and '''<span style="color:#ff0000">repaired</span>''' using separate PDS stitches. The distal apex of the corpora needs to be closed with a second running suture, and '''a slightly shorter prosthetic cylinder is selected for the perforated side;''' this is necessary to prevent the distal tip of the cylinder from resting on the urethral suture repair.
*** '''A more conservative approach would be to terminate the procedure and bring the patient back for implantation 3 months later.'''
**** The disadvantage of this strategy is that the length of the shaft is foreshortened, and dilation of the scarred corpora is much more difficult.
*** '''If the perforation occurs after both corpora are dilated, a semimalleable cylinder can be placed in the nonperforated side to preserve penile length.'''
* '''<span style="color:#ff0000">Proximal perforation'''
** '''Evaluated by placing a dilator in each crura, and their heights can be compared to confirm that one has penetrated too deeply inside the perineum.'''
** '''<span style="color:#ff0000">Management'''
*** '''<span style="color:#ff0000">Repair</span>''' by anchoring the cylinders to the surrounding corpora tissue by placing stitches above and below the input tubing, which prevents the cylinder from proximal migration and allows the perforation to heal.

==== Urethral perforation ====
* '''<span style="color:#ff0000">Management'''
** '''<span style="color:#ff0000">Abandon the procedure and divert the urine with a urethral catheter''' until deferred repair.
*** '''Urethral repair would be difficult and is unnecessary.'''
*** '''If the contralateral malleable cylinder has already been placed and there is no septal perforation, then it may be left in place.'''
*** '''If this occurs with an inflatable prosthesis, the entire device should be removed and the urethra allowed to heal.'''