Introduction: The Penuma penile implant (PPI) is a subdermal hemi-circumferential silicone implant intended to increase penile length and girth. Only one case report and one case series of four patients have been published on the complications of PPIs. We present a single center experience treating complications of the PPI both prior to and after implant removal.
Methods: Patients with a prior history of PPI surgery treated at our center were identified between 2012 and 2021. Demographic data, implant date, complications leading to explant, postoperative course, and functional outcomes were recorded. Our protocol is to wait 6 months after explant prior to scar excision (SE)/revision should disabling capsular contraction develop.
Results: A total of 12 patients were evaluated at our institution. Mean age at time of implant was 40.1 years. The median duration of implant was 3 months (range 3 days-33 months). Mean follow-up was 20 months. The most common complication leading to explant was distal lateral protrusion of the implant at the coronal margin causing patient and partner discomfort which occurred in 7 patients. Adverse sensation changes occurred in 2 patients after implant. Other reasons for explant were skin erosion, infection, ventral curvature, and penile shortening each occurring in 1 patient. Following explant 8 (67%) patients developed disabling dorsal curvature, 7 (58%) patients had penile shortening, 3 (25%) had infections, 2 (16%) had de novo sensation changes, 2 (16%) had erectile dysfunction, and 1 (8%) had right lateral curvature. Curvature occurred because of capsule contraction following explant. Of those with disabling curvature, 3 (43%) underwent SE, 2 (25%) are awaiting SE, and 2 (25%) more are considering SE for disabling curvature. In patients who underwent SE, severe scarring was noted superficial to the neurovascular bundles. All patients who have undergone SE had improvement in curvature and were able to have functional erections.
Conclusions: PPI for cosmetic penile enhancement can be associated with a variety of complications leading to device removal. Subsequent to explant, capsular contraction can result in disabling curvature and penile shortening which can be managed successfully with SE.