(62) tunneling in a case of severe cavernous fibrosis after penile implant infection

Abstract Objectives Penile implant can be a challenging procedure when cavernosal fibrosis is encountered. In some cases, a second incision and more aggressive maneuvers may be necessary, such as fibrotic tissue ressection, widening of the corporotomies, and grafting in order to close the cavernous bodies. Tunneling is a less invasive technique that allows the development of a space inside the cavernous body to implant the prosthesis. Methods We present a case of a 36-year-old patient who underwent suspensory ligament section and, later on, an implant of a two-piece inflatable penile prosthesis. He presented to our hospital a month later, with sepsis and a penoscrotal abscess. After urgent removal of the prosthesis and skin debridement, the patient developed a urethrocutaneous fistula that was subsequently repaired. A physical examination was performed, fibrosis didn’t allow penile stretching. Patient was scheduled for a three-piece inflantable penile prostesis implant. Results In this video we show a step-wise management of a patient with cavernosal fibrosis. After development of a space with Metzembaum scissors, tunneling is performed with Mooreville Uramix dilators and Rosselló cavernotomes. This made possible the implantation of a Titan Touch narrow-base penile prosthesis. Conclusions Tunneling of the cavernosal bodies is a useful technique in cases with extensive cavernosal fibrosis due to previous infection. Conflicts of Interest No conflict of interest.