title: Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review.
abstract: BACKGROUND
  Penile prosthesis has become one of the most accepted treatment options in patients who do not respond to conservative medical therapies (oral or intracavernous injections). When penile fibrosis is present, this surgery becomes a real surgical challenge even for a skillful surgeon.
  
  
  OBJECTIVE
  The aim of this study was to review latest techniques to implant a penile prosthesis in patients with corporal fibrosis.
  
  
  METHODS
  We performed a systematic search in the following databases: PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index without any date limits for the terms: "penile prosthesis,""penile fibrosis,""impotence,""fibrosis,""cavernotomes,""downsized prosthesis cylinders,""patient satisfaction,""penile graft," and "vascular graft."
  
  
  METHODS
  We reported in each technique and series data regarding penile size, complication rate, infection rate, technical pitfalls and details, use of additional surgical tools or implanted material (grafts, etc.), patients' satisfaction, and overall success rate.
  
  
  RESULTS
  When penile corporal fibrosis is present, this surgery becomes a real surgical challenge even for a skillful surgeon. Over the years, multiple surgical approaches have been suggested to facilitate implantation in this difficult situation. Traditional approaches include the resection of scar tissue, performing extensive corporotomies and the eventually use of grafts to cover the corporal gap. Outcomes can be improved combining the use of techniques for scar incision (extensive wide excision, multiple incisions minimizing excision, corporal counter incisions, corporal excavation technique or Shaeer's technique) and cavernotomes and downsized prosthesis. Surgical strategies like upsizing prosthesis, suspensory ligament release or scrotoplasty must be kept in mind to utilize in this special scenario.
  
  
  CONCLUSIONS
  Penile prosthesis in a patient with severe corporal fibrosis remains a surgical challenge. There are several techniques and surgical strategies that an implant surgeon should know and manage to minimize complications and improve outcomes.
authors.affiliation: Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Department of Urology, Madrid, Spain. jims09@me.com
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martínez-Salamanca
authors.forename: Alexander
authors.initials: A
authors.lastname: Mueller
authors.forename: Ignacio
authors.initials: I
authors.lastname: Moncada
authors.forename: Joaquin
authors.initials: J
authors.lastname: Carballido
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005355:Fibrosis; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015917:Penile Prosthesis; D019919:Prosthesis Implantation; D013521:Urologic Surgical Procedures, Male / Q000379:methods*