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Case Reports
. 2023 Feb 15:15:85-89.
doi: 10.2147/RRU.S387042. eCollection 2023.

A Unique Case of Inflatable Penile Prosthesis (IPP) Implantation and Mesh Phalloplasty in a Patient Born with Congenital Fusiform Megalourethra

Alfredo Berrettini  1 , Irene Paraboschi  1 , Massimo Di Grazia  1 , Michele Gnech  1 , Guglielmo Mantica  2 , Dario Guido Minoli  1 , Erika Adalgisa De Marco  1 , Gianantonio Manzoni  1 , Marco Capece  3 , Alessandro Palmieri  3 , David Ralph  3 , Vincenzo Mirone  3
Affiliations
Case Reports

A Unique Case of Inflatable Penile Prosthesis (IPP) Implantation and Mesh Phalloplasty in a Patient Born with Congenital Fusiform Megalourethra

Alfredo Berrettini et al. Res Rep Urol. .

Abstract

We present the first case of a patient born with congenital fusiform megalourethra who underwent the successful placement of an inflatable penile prosthesis (IPP) and mesh phalloplasty due to primary erectile dysfunction (ED). After an extensive psychosexual assessment and a preoperative MRI scan, an IPP was successfully implanted. The procedure was carried out through a penoscrotal approach, which offered excellent exposure to the crura and the proximal ends of the corpora cavernosa. Following the incision and the dilatation of both corpora cavernosa, the penile cylinders were inserted and a mesh phalloplasty was performed, to replace the erectile tissues lacking in the distal corpora cavernosa. After reservoir and pump placement, the device was tested, and no mechanical issues were recorded. The postoperative course was uneventful, and, at the 2-year follow-up, the patient reported highly satisfactory results, with valid functional erections.

Keywords: congenital fusiform megalourethra; erectile dysfunction; inflatable penile prosthesis; phalloplasty.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Preoperative MRI scan of the penis and pelvic floor. Sagittal (A) and axial (B and C) images showed severe hypoplasia of the corpus spongiosum and distal deficiency of both corpora cavernosa. The prostate gland was small and almost difficult to identify. These findings were compatible with the diagnosis of the fusiform variety of congenital megalourethra.
Figure 2
Figure 2
Intraoperative images showing the configuration of the inflatable penile prosthesis (IPP). Due to the lack of erectile tissue in the distal corpora cavernosa, an Ultrapro® Macroporous Partially Absorbable Mesh (Ethicon US LLC) shaped as a 6-cm rounded cap was shaped (A) and secured at the tip of the cylinders of the IPP (B and C).
Figure 3
Figure 3
Postoperative pictures documenting valid penile erections. Highly satisfactory results were documented at the end of the surgical procedure (A) and at the 2-year follow-up (B and C). A maximally turgid state was achieved by inflating the three-piece IPP using the scrotal pump placed in the right subdartos pouch.
See this image and copyright information in PMC

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