Complications of the penuma penile implant for genital enhancement

Abstract Introduction The Penuma penile implant (PPI) is a subcutaneous silicone implant intended to increase penile length and girth. Only one case report and one case series of four patients have been published on the complications of PPIs. Objective To report a single center experience treating complications of the PPI both prior to and after implant removal. Methods Patients with a prior history of PPI surgery treated at our center were identified between 2012 and 2022. Demographic data, implant date, complications leading to explant, postoperative course, and functional outcomes were recorded. Our protocol is to wait 6 months after explant prior to scar excision (SE)/revision should disabling capsular contraction develop. Results A total of 13 patients were evaluated at our institution. Median age at time of implant was 36 (26-54) years. The median duration of implant was 3 months (range 3 days-33 months). Mean follow-up was 21.6 months. The most common complication leading to explant was distal lateral protrusion of the implant at the coronal margin causing patient and partner discomfort which occurred in 8 patients. Other reasons for explant were skin erosion, infection, decreased sensation, ventral curvature, and penile shortening each occurring in 1 patient. Adverse sensation changes occurred in 2 patients after implant. Following explant 9 (69%) patients developed disabling dorsal curvature, 8 (62%) patients had penile shortening, 3 (23%) had infections, 2 (15%) had de novo sensation changes, 2 (15%) had erectile dysfunction, and 1 (8%) had right lateral curvature. Curvature occurred because of capsule contraction following explant. Of those with disabling curvature, 6 (67%) underwent scar excision (SE), 1 is awaiting scar maturation for SE, 1 more is considering SE for disabling curvature, and 1 has elected not to undergo further surgery. In patients who underwent SE, severe scarring was noted superficial to the neurovascular bundles. All patients who have undergone SE had improvement in curvature and were able to have functional erections. Conclusions PPI for cosmetic penile enhancement can be associated with a variety of complications leading to device removal. Subsequent to explant, capsular contraction can result in disabling curvature and penile shortening which can be managed successfully with SE. Disclosure No