Revision of penile prosthesis surgery after use of penile traction therapy to increase erect penile length: case report and review of the literature

Introduction: Erectile dysfunction, a common consequence of radical prostatectomy (RP), can be managed with placement of a penile prosthesis. Patient satisfaction and functional outcomes have been related to penile length after prosthesis placement.

Aim: We report a case demonstrating the impact of daily penile traction therapy in a patient with a previously placed penile prosthesis with the goal of enabling revision with a longer device.

Methods: A post-RP patient who underwent inflatable penile prosthesis placement 6 years ago complained of inability to maintain partner penetration with his device. The patient underwent vacuum erection device therapy twice daily for 10 minutes per session for approximately 1 year as well as 8 hours of penile traction therapy daily for 8 months. A revision implant surgery was subsequently attempted.

Main outcome measure: Patient reported functional outcome.

Results: Stretched penile length increased 2.3 cm after 6 months of traction therapy. A revision surgery enabled the placement of a prosthesis that was 20% longer in length (15 cm to 18 cm), and erect penile length increased by 4.4 cm. The patient reported that the new prosthesis enabled satisfactory maintenance of partner penetration.

Conclusions: This case suggests that the use of a penile traction device increases penile corporal length, and thus the length of a penile prosthesis that can be implanted in a patient with an unsatisfactory prosthesis already in place. Importantly, this patient experienced a substantial improvement in erect penile length after surgery. It is unknown whether these results are generalizable, either to all patients with a previously placed prosthesis or pre-prosthesis patients, representing an opportunity for further investigation.