Rigi10™ Malleable Penile Prosthesis
Also Known As
Proximal corporoplasty, Crural reconstruction, Proximal corporal corporoplasty, Proximal penile reconstruction, Crural corporal repair, Proximal corpora cavernosa reconstruction, Proximal penile corporoplasty
Definition
Proximal corporal reconstruction is a specialized urological surgical procedure that involves the repair and reconstruction of the proximal portion of the corpora cavernosa, the paired cylindrical structures within the penis responsible for erectile function.1 This technique addresses structural abnormalities, deformities, or damage in the proximal corporal bodies, typically near the crura where they attach to the pubic bone.2 The procedure may involve various reconstructive methods including tissue grafting, synthetic material placement, or specialized corporoplasty techniques to restore anatomical integrity and functional capacity of the erectile mechanism.3 Proximal corporal reconstruction is often performed in conjunction with penile prosthesis implantation to address complications such as proximal corporal dilatation, rupture, or fibrosis that may compromise prosthetic device function and stability.4 The primary purpose of this procedure is to create a stable anatomical foundation for proper penile prosthesis positioning, preventing proximal migration and ensuring optimal device function in patients with erectile dysfunction.5
Clinical Context
Proximal corporal reconstruction is primarily indicated in specific clinical scenarios where the structural integrity of the proximal corpora cavernosa is compromised, affecting erectile function or penile prosthesis stability.1 The procedure is most commonly performed in the following contexts:
1. Revision Penile Prosthesis Surgery: In patients with previous inflatable penile prosthesis (IPP) implantation who develop proximal corporal deformities, including corporal dilatation (expansion of the corporal space) or corporal rupture, which can lead to device malfunction, aneurysmal dilatation, or device breakage.1 Studies have shown that these deformities are often associated with long-term IPP use, with a median treatment duration of approximately 14 years before revision becomes necessary.1
2. Severe Corporal Fibrosis: In patients with significant fibrosis of the corpora cavernosa due to conditions such as Peyronie’s disease, priapism, or previous explantation of an infected penile prosthesis.2 These patients often require specialized surgical techniques to create adequate space for prosthesis placement while maintaining structural integrity.2,4
3. Proximal Perforation During Implantation: When crural perforation occurs during the dilation phase of penile prosthesis implantation, proximal corporal reconstruction techniques using synthetic vascular grafts fashioned into a cup-like structure can be employed to repair the defect and stabilize the prosthesis.3
4. Prevention of Proximal Migration: In cases where there is concern about potential proximal migration of the penile prosthesis cylinders, which can lead to decreased functional length and patient dissatisfaction.3,4
Patient selection criteria typically include men with erectile dysfunction who have failed or are not candidates for less invasive treatments, and who present with specific anatomical challenges in the proximal corpora that would compromise standard penile prosthesis implantation.4 The surgical procedure varies based on the specific deformity but generally involves careful corporal dissection, specialized dilation techniques, and in some cases, the use of graft materials (autologous or synthetic) to reconstruct the proximal corpora.2,4
Expected outcomes following successful proximal corporal reconstruction include stable prosthesis positioning, prevention of device migration or malfunction, and ultimately, successful sexual intercourse with high rates of patient satisfaction.1 Studies have reported that properly performed reduction corporoplasty with appropriate device replacement can achieve successful sexual function in nearly all patients within 6 months of surgical revision.1