INITIAL EXPERIENCE WITH PROCESSED HUMAN CADAVERIC ALLOGRAFT SKIN FOR RECONSTRUCTION OF THE CORPUS CAVERNOSUM IN REPAIR OF DISTAL EXTRUSION OF A PENILE PROSTHESIS

T he ideal replacement material for repairing defects in the tunica albuginea has yet to be defined. Current experience has used synthetic or harvested natural materials to reconstruct defects present in the corpora cavernosa. Synthetic materials have included polytetrafluoroethylene products such as Gore-Tex, Marlex, and Dacron. These materials are readily available, resilient, and inert. However, complications surrounding their use have been observed, including inelasticity of the graft and formation of a reactive capsule around the patch. Several investigators have reported a high rate of infectious complications with polytetrafluoroethylene grafting. Knoll et al.1 reported a 30% infection rate in 57 patients with cavernous fibrosis who received a prosthesis with synthetic graft material and a 5% infection rate in a similar group of 20 patients who received a downsized inflatable prosthesis to obviate the need for synthetic grafting. Similarly, Jordan et al.2 reported three infections in 7 patients with synthetic grafts on penile implants for phallic reconstruction. Corporal defects have also been repaired with autologous grafts, including dermis, vein segments, temporalis fascia, and tunica vaginalis.3–6 These materials have the advantage of being nonimmunogenic and are less likely to become infected. However, harvesting autologous grafts may extend the operative time, and these grafts may lack the tensile strength and distensibility of the synthetic materials presently available.7 Additionally, donor site pain and morbidity can be significant. We report our preliminary experience with processed human cadaveric allograft skin in reconstruction of a damaged corpus cavernosum. The patient required repair of a two-piece inflatable penile prosthesis (Mentor Mark II) with right distal cylinder extrusion and left distal cylinder crossover. MATERIAL AND METHODS A 63-year-old man presented with penile pain and was found to have extrusion of the right distal cylinder 4 years after a radical retropubic prostatectomy and 2.5 years after insertion of a two-piece self-contained Mentor Mark II penile prosthesis. This cylinder was palpable beneath the skin just proximal to the glans penis. Additionally, the left cylinder was found to have crossed into the right corpora distally. His past medical and surgical histories were otherwise unremarkable. OPERATIVE TECHNIQU