Rigi10™ Malleable Penile Prosthesis
Also Known As
Cylinder crossover, prosthetic crossover, septal perforation with crossover, intercorporal cylinder migration, corporal chamber crossover
Definition
Corporal crossover is an intraoperative or postoperative complication of penile prosthesis implantation where a prosthetic cylinder inadvertently crosses from one corpus cavernosum to the other through a perforation or fenestration in the corporal septum1. This complication occurs when the dilator, Furlow instrument, or prosthetic cylinder penetrates the septal wall during corporal dilation or cylinder placement, creating an abnormal communication between the two corporal chambers2. The fenestrated structure of the middle and distal corporal septal wall makes it particularly susceptible to violation during instrumentation3. This crossing can occur at either proximal or distal locations within the corpora cavernosa, with distal crossovers being more commonly reported4. The condition results in asymmetrical cylinder placement, which can cause penile deformity, shortening, and dysfunction if not promptly recognized and corrected5.
Clinical Context
Corporal crossover is clinically encountered during inflatable penile prosthesis (IPP) implantation procedures, particularly in patients with specific risk factors1. The complication is more frequently observed with infrapubic or subcoronal surgical approaches compared to the penoscrotal approach2. Risk factors include corporal fibrosis, Peyronie’s disease, previous pelvic radiation, and technical surgical errors3.
Intraoperatively, crossover may be suspected when there is asymmetrical corporal length measurement during the “goal post test,” difficulty inserting the second cylinder, or audible “clinking” of metal instruments during dilation4. Clinical signs include off-midline positioning of the urethral catheter when the prosthesis is activated and atypical penile appearance during inflation5.
Postoperatively, patients may present with painful leftward or rightward penile curvature during erections, incomplete prosthesis deflation, tilted glans, or asymmetrical erected penis when cylinders are inflated1. The diagnosis is typically confirmed through magnetic resonance imaging (MRI), which can clearly demonstrate the abnormal cylinder positioning5.
Treatment requires surgical correction through corporotomy, septal reconstruction (often using biological grafts such as Tutoplast), and redirection of the displaced cylinder into the appropriate corporal space1. Advanced techniques include the distal corporal anchoring stitch method, which has shown excellent outcomes with minimal complications2. Success rates for surgical correction are high when performed by experienced prosthetic urologists, with most patients achieving restored erectile function and device cycling4.