Unforeseen Outcome in Hydrocele Repair: Implications of Three-Piece Inflatable Penile Prosthesis Placement

Ali Pasyar, Matthew Megson, Parth Tagdiwala, Tobias S. Kohler, David J. Ralph, Wai G. Lee

penile prothesis, bladder injury, hydrocele, delayed presentation, revision surgery

Two months after an infrapubic penile prosthesis (IPP) insertion abroad, a 53-year- old gentleman presented to NHS services with issues relating to its function and a scrotal bulge which enlarged with activity. Later, MRI imaging identified that a hydrocele had formed around the prosthesis pump.

The aim of this video case report is to describe the surgical correction of this presentation and identify the potential underlying cause.

The corrective surgery began with a transverse skin and dartos muscle incision, and corporotomy. The right-side IPP cylinder was removed first, followed by the second IPP cylinder (left). Rear-tip extenders, each measuring 7.5 cm, were removed from each cylinder. The original IPP was replaced with a new, malleable prosthesis. The original infrapubic surgical site was reopened to allow fluid to be drained (75 ml) and the reservoir to be removed.

Following removal of the first IPP cylinder, 150 ml of fluid was released from the hydrocele. This fluid was sent for microscopy, sensitivity, and culture. The following investigations were conducted intra-operatively to try and identify its source: urethrogram, cavernoscopy, cystoscopy with methylene blue stain, and bladder distension.

All investigations results were unremarkable. The only significant finding was a small bladder wall defect on cystoscopy.

Preoperatively,the cause of this hydrocele was unknown. Intraoperative investigations excluded common causes such as infection, prosthesis leak and fistula. We hypothesize that a missed bladder injury during the initial IPPsurgery resulted in a connection which ran from the bladder, along the reservoir tubing, into the right hemi-scrotum, and the penile prosthesis pump.This video demonstrates an unforeseen finding during hydrocele repair and therarepresentationofapotential delayed bladder injury. It also illustrates the step wise approach the surgeons employed to successfully correct and investigate the cause of this unforeseen urological complication.

None.

The authors have nothing to disclose

Kohler, T.S. Surgical Masterclass series. London;  Westmoreland Street, UCLH. May 26,

2023