Long-term urethral erosion and scrotal extrusion of a penile prosthesis: case report and literature review

Introduction The extrusion of a penile prosthesis is an uncommon complication that has been associated with several risk factors, such as infection, trauma, or vigorous sexual activity. It is a morbid and undesirable condition, for which the definitive management is the surgical extraction of the prosthesis. Clinical case The case is presented of a 59-year-old patient, with no clinical history, who had an inflatable, three-part penile prosthesis implanted four years earlier. Two months after the surgical procedure, he presented with an extrusion of the reservoir at the scrotum, of one of the connection tubes through the penoscrotal junction, and the urethral erosion of one of the cylinders that protruded through the urethral meatus. The patient consulted almost four years after the initial extrusion, complaining of obstructive and irritative urinary symptomatology. He had no pain. In the physical examination, the prosthesis was extruded at the aforementioned places, with no local or systemic signs of infection or inflammation. He was completely asymptomatic previously, and the prosthesis was functional despite being extruded. He was taken into surgery for surgical exploration and extraction of the prosthesis, without any complications. Discussion The extrusion of the penile prosthesis is a rare adverse event, which usually culminates in its surgical removal. It has been described as secondary to an infectious process or to tissue trauma during the vigorous sexual activity, especially in patients with decreased sensitivity due to neurological injury or diabetes mellitus. Intraoperative factors have been described, such as the implanting of an oversized prosthesis, vigorous dissection of the corpus cavernosum, and mechanical pressure. Conclusion In our case, the patient did not have any of the aforementioned commonly described risk factors. The asymptomatic status of the patient for so long is remarkable, as well as the functional status of the prosthesis despite the extrusion, which could be secondary to a resolved, mild infectious process. In the absence of clear risk factors, more studies are need on the pathophysiology of the extrusion. This could be secondary to an immunological response to a foreign body or an anatomical predisposition to extrude due to a ventral weakness of the tunica albuginea.