Overcoming Challenges in Retrieving an Encapsulated Rear Tip Extensor During Conversion From Malleable to Inflatable Penile Prosthesis Surgery: A Case Report and Review of Literature

Insertion of inflatable penile prosthesis (IPP) is generally regarded as a safe procedure, with low rates of complications. However, when complications do arise, they can pose significant challenges to both patients and surgeons. Patient optimization and adherence to specific intraoperative protocols are crucial in mitigating the risk of surgical complications. Standardization of intraoperative management, including the administration of intravenous antibiotics, meticulous aseptic techniques, and antibiotic irrigation of the prosthesis, is paramount. Furthermore, having the appropriate set of instruments can reduce operative time and minimize tissue manipulation. While the literature predominantly focuses on outcomes such as infection, prosthesis malfunction, corporal perforation, and penile length loss, reports on managing retained prosthetic components are rare. This uncommon complication raises important considerations regarding whether foreign bodies should be left in place or removed during revision penile prosthetic surgeries. We present the case of a 49-year-old male who underwent IPP insertion. Following complications due to infection, salvage penile prosthetic surgery was performed 38 days after penile prosthesis insertion, using a temporary malleable implant. Subsequently, eight months later, the patient underwent surgery for the replacement of the malleable implant with an IPP. During the replacement procedure, the right-side malleable component was removed easily, while the left-side component was discovered to have the rear tip missing. Removal attempts using intracorporeal rigid cystoscopy and graspers were unsuccessful, necessitating a perineal counter incision for retrieval. After successfully removing the encapsulated extensor, a new IPP was successfully placed without complications.