Two months after undergoing an infrapubic inflatable penile prosthesis (IPP) insertion abroad, a 53-year-old man presented with an unsupported, flaccid shaft upon inflation and a right scrotal bulge that enlarged with physical activity. MRI imaging indicated a hydrocele surrounding the prosthesis pump. This case report describes the surgical correction and investigation into the root cause of these complications. The procedure began with a transverse penoscrotal incision to access and remove the prosthesis cylinders, revealing turbid hydrocele fluid around the right cylinder, which was aspirated for microbiological testing. The left cylinder and the rear-tip extenders (RTEs) on each side were then removed, allowing for the extraction of a 20 cm IPP with 7.5 cm RTEs. The site was rinsed with Rifampicin/Gentamicin, and a malleable 26 cm prosthesis was inserted. Additionally, the previous infrapubic wound was reopened to remove the reservoir, where 75 ml of turbid fluid was aspirated.
Further investigation with flexible cystoscopy showed no fistula in the bladder, urethra, or abdominal cavity. Methylene blue tests initially showed no leakage, but further bladder filling led to fluid drainage from the incision, suggesting a possible fistula linking the bladder to the reservoir, traveling along the reservoir tubing to the scrotum and pump. The surgery concluded with the replacement of the inflatable prosthesis by a malleable one, a suprapubic catheter insertion, and hydrocele drainage. Post-surgery, the patient recovered well, and fluid cultures showed no infection. A follow-up cystogram revealed no bladder leaks, and the patient expressed satisfaction with the prosthesis outcome, with plans for an inflatable device exchange later.
