Joshi, P.M., Ocampo, M, Navarro, J, Kulkarni, S.B.

neophallus, penile prosthesis, epispadias, semi-rigid prosthesis

Males with epispadias might need neophallus reconstruction, as they have a high risk of penile loss after the initial closure. Sexual function and the ability for penetrative intercourse are crucial in managing these patients. This video demonstrates the implantation of a semirigid penile prosthesis in a young patient with a previous epispadias repair. A two-cylinder prosthesis was chosen based on the patient's wishes. The patient had undergone phalloplasty and urethroplasty for urethro-cutaneous fistula closure was done 6 months before penile prosthesis implant. Before the procedure, the patient underwent a CT scan and MRI to assess the corpora, revealing the absence of the right corpora. In this video, we demonstrate step by step the insertion of a two-cylinder semirigid penile prosthesis in this complex case. The left corpora was fibrotic, making dilation difficult.  The right sided corpora during dissection, was found to be short and deep, dissection was performed until the pubic tubercle and the pubic bone could be felt, distal dilatation was done on the neo-phallus. The right-side cylinder was placed in the pubic tubercle, three stay sutures where placed between the bone and the cylinder to fix it proximally. A small polypropylene mesh was placed to cover the left corpora. This video demonstrates that a two-cylinder penile prosthesis can be successfully implanted in a patient with a neophallus.

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