Management of Urethral Injury During Penile Prosthesis Surgery

There has been relatively little research into the management of intraoperative urethral injury during insertion of penile prostheses. In this review, we describe how such injuries can occur and the common management strategies. There are no randomized trials or level 1 evidence for managing such intraoperative urethral injury, and most literature are small retrospective series, expert opinions, or systematic reviews that combine small observational studies. Anatomical considerations, corporal fibrosis, and Peyronie’s disease present risk factors for urethral injury. Injuries can be classified by location at the distal urethra (meatus to fossa navicularis), mid-urethra (fossa navicularis through pendulous urethra), or proximal urethra (proximal penile urethra to distal bulbar urethra). There is no true consensus on what actions to take when a urethral injury does occur, and management is changing over time. While the traditional course has been to abort the procedure, some surgeons now choose to repair the defect and proceed with prosthesis implantation. Urethral injury is a rare but serious complication during penile prosthesis insertion. Management is heterogenous and is heavily dependent on the location of the injury and the preference and experience of the surgeon.