Rigi10™ Malleable Penile Prosthesis
Also Known As
Glans hypermobility, Glans droop, Supersonic transporter deformity, Glans insufficiency syndrome, SST deformity
Definition
Floppy Glans Syndrome (FGS) is a potential complication of penile prosthesis implantation in patients with erectile dysfunction, characterized by the lack of rigidity and hypermobility of the glans penis despite full inflation of the prosthetic cylinders.1 This condition manifests as a ventral, dorsal, or lateral droop of the glans during erection, which can cause affected patients to complain of painful, unsatisfying, or otherwise difficult attempts at sexual intercourse.2 In severe cases, incorrect cylinder sizing can result in extreme conditions such as flail penis or S-shaped deformity.3 FGS affects a very small proportion of patients who undergo penile prosthesis implantation, with reported incidence ranging from 0.04% to 10%.4
Clinical Context
Floppy Glans Syndrome is primarily observed in patients who have undergone penile prosthesis implantation for erectile dysfunction.1 The condition is more commonly encountered in patients with moderate to severe corporeal fibrosis, which makes distal dilation to the tip of the corpora more difficult during implantation.2 This fibrosis is frequently found in patients with extensive Peyronie’s disease, those who have undergone previous explantation of an infected penile implant, or patients who have had shunt surgery for refractory ischemic priapism.2
The pathophysiology of FGS involves insufficient compression of the deep dorsal and circumflex veins between the Buck fascia and the corpora cavernosa, even when cylinders are maximally inflated.1 When adjacent tissue does not adequately restrict blood flow through these vessels, glanular tumescence becomes increasingly difficult to achieve, particularly in patients with severe erectile dysfunction who have poor glanular blood flow at baseline.1 FGS can also result from poor underlying glanular structural support, making droop possible even when cylinders have appropriate size and position.1
Diagnosis requires careful physical examination with a fully inflated implant to determine the direction of the droop, which can help distinguish the underlying cause of the deformity.2 In ambiguous cases obtaining a correct diagnosis will often involve imaging—magnetic resonance imaging or penile ultrasound scanning of the inflated device.2 Cooperation with an experienced uroradiologist is invaluable in such cases.2
Treatment options range from medical management to surgical correction.1 Initial approaches typically include oral or topical application of vasoactive drugs.3 When medical therapy fails, surgical interventions such as distal penoplasty and glanulopexy have been described as effective methods of correcting the FGS deformity.1 These surgical options are especially valuable in patients who undergo adequate cylinder sizing intraoperatively, avoiding the more invasive option of prosthetic cylinder replacement.1 Glanspexy is typically performed through a subcoronal incision, which allows access to the space between the spongiosum of the glans and the underlying tunica albuginea, using anchoring sutures.3 Studies have shown that approximately 75% of patients are satisfied with the outcome of glanspexy surgery.3