Rigi10™ Malleable Penile Prosthesis
Also Known As
Corporal asymmetry, Asymmetric corporal measurements (ACM), Corporal length discrepancy, Penile corporal asymmetry, Intracorporal length difference
Definition
Size discrepancy refers to the difference in measured corporal length between the two sides of the penis, often indicating perforation or anatomical variation that requires clinical attention during penile implant procedures.1 This condition is characterized by asymmetric corporal measurements (ACM) that can affect surgical outcomes and patient satisfaction with penile prosthetic implants.2 Size discrepancy may result from various etiologies including measuring error, iatrogenic injury, or true anatomical asymmetry.2 The clinical significance of this finding lies in its potential impact on cylinder sizing during inflatable penile prosthesis (IPP) placement, which can affect postoperative penile curvature and overall functional outcomes.3
Clinical Context
Size discrepancy is a clinically significant finding encountered during inflatable penile prosthesis (IPP) placement procedures.2 The etiology of this condition includes measuring error, iatrogenic injury during corporal dilation, and true anatomical asymmetry.2 When identified intraoperatively, prosthetic surgeons should follow a systematic troubleshooting approach that includes remeasuring after redilation using a fixed point to record proximal and distal measurements, ruling out urethral injury or distal perforation with corporal irrigation, assessing for crossover by inserting corporal dilators both proximally and distally, and evaluating for proximal perforation.2
Research indicates that approximately 20.1% of patients undergoing primary IPP surgeries have idiopathic corporal asymmetry.2 Notably, no preoperative factors, including Peyronie’s disease, have been found to be predictive of asymmetric corporal measurements.2 Even among patients without Peyronie’s disease, 17.3% demonstrate corporal asymmetry.2
Management of size discrepancy during IPP surgery remains a point of debate among prosthetic surgeons.2 Some advocate for true-to-size cylinder placement regardless of asymmetry, while others recommend placement of a symmetric device if measurements are within 1 cm.2 Critics of symmetric device placement argue that using a cylinder longer than the corporal space allows may increase the risk of postoperative curvature, while an undersized cylinder could result in supersonic transporter deformity.2
Clinically significant (0.5 cm or greater) decreases in measured corporal lengths have been noted in patients with Peyronie’s disease or a history of radical pelvic surgery.3 Intra-patient discrepancy in cylinder size (>1 cm) is rare, occurring in only 2.7% of cases, and should prompt thorough investigation when encountered.3