Revision surgery replaces or repairs a penile prosthesis that has failed mechanically, become infected, eroded, or produced a poor cosmetic and functional result. It is technically harder than a first implant and depends heavily on the surgeon’s experience with scarred corpora.
Also referred to as: penile prosthesis replacement, implant salvage surgery, redo penile implant, failed penile implant repair.
Why implants need revising
A penile prosthesis is a mechanical device inside a living, healing body, and either half of that equation can go wrong. Roughly one implant in five will need some form of revision within fifteen years — most often for straightforward mechanical wear, sometimes for infection, and not infrequently because the original operation left a technical problem that was never corrected.
Revision is not simply the first operation repeated. The corpora are lined by a fibrous capsule, the tissue planes from the original approach are scarred, and the reservoir may be adherent to structures it was never meant to touch. The proportion of a revision case spent on dissection and reconstruction, rather than on implantation itself, is what separates it from a primary procedure — and it is why we ask to see your operative notes and device card before agreeing to a date.
The problems we are asked to correct
Most referrals to our revision service fall into one of the following groups. Each is fixable, but each demands a different operative plan.
| Presentation | What is usually happening | How it is corrected |
|---|---|---|
| Loss of rigidity, device will not hold inflation | A fluid leak from a cylinder, tubing or the reservoir, or a failed pump valve | Component exchange where the rest of the device is sound; full replacement where the implant is more than eight to ten years old |
| Redness, discharge, fever, pump fixed to the skin | Device infection, most often with skin flora such as coagulase-negative staphylococci | Explant with a Mulcahy-type antiseptic washout sequence and immediate re-implantation, or removal with delayed replacement after three to six months |
| Glans hangs forward when the device is inflated | SST deformity — cylinders under-sized distally, leaving the glans unsupported | Cylinder re-sizing with rear tip adjustment, and glanspexy where needed |
| The device inflates by itself, or the reservoir is visible | Auto-inflation from an over-filled or poorly placed reservoir, or a failed lock-out valve | Reservoir repositioning, usually to a submuscular site, with lock-out valve replacement |
| Persistent bend or hourglass despite the implant | Untreated Peyronie’s plaque, or residual curvature after inadequate modelling | Manual modelling over the inflated device, plaque incision, or grafting at the time of exchange |
| Pain on inflation, or a device that feels too long | Over-sized cylinders or impending erosion at the crus or glans | Downsizing with shorter cylinders, distal corporoplasty where erosion has begun |
| Short, hard, scarred penis after a previous explant | Dense corporal fibrosis following infection or a device removed and left out | Staged corporal excavation with cavernotomes, downsized cylinders, and grafting of the tunica where needed |
Salvage: treating an infected device
An infected prosthesis will not clear with antibiotics. Bacteria colonise the device surface in a biofilm that antibiotics cannot penetrate at any achievable dose, so the device itself has to go. The question is only whether a new one goes back in immediately.
Where the infection is confined to the device and the tissues are not frankly necrotic, we perform an immediate salvage. The implant and all capsule debris are removed, and the corporal, scrotal and reservoir spaces are irrigated through a defined sequence of antiseptic and antibiotic solutions, with instruments, gowns and gloves changed before a new device is placed. Published success rates for this approach sit above 80%, and it has one decisive advantage over waiting: it preserves length. Corpora that are left empty scar down and shorten quickly.
Where there is systemic sepsis, purulence in the corpora, extensive tissue loss or diabetic ketoacidosis, immediate salvage is unsafe. In those cases the device is removed, the patient is treated with culture-directed antibiotics, and re-implantation is planned at three to six months — accepting that the second operation will be harder and that some length will be lost.
What we need before you travel
A revision case cannot be planned from photographs alone. Sending these in advance is what lets us give you a realistic operative plan and a firm quotation rather than a guess.
- The operative report from your original implant, and any subsequent procedures
- The device identification card — manufacturer, model, cylinder length and serial numbers
- The date the device was implanted and the date the problem started
- Any wound swab or urine culture results, if infection is suspected
- A recent HbA1c, full blood count, CRP and coagulation screen
- A pelvic CT or ultrasound where the reservoir position is uncertain or a previous abdominal operation has been performed
Setting expectations for revision
Revision outcomes are good, but they are not identical to first-time surgery and it is important that this is said plainly.
- Infection risk in revision surgery runs at roughly 3–5%, against 1–2% for a primary implant.
- Some length loss is common where the previous device was removed and not replaced promptly, or where infection caused fibrosis.
- Operating time is longer and recovery is typically a week or two slower than a first implant.
- A device that failed purely mechanically, exchanged promptly, generally returns function equal to the original result.
- Where the corpora are severely scarred, we may recommend a malleable device rather than an inflatable one — a functioning implant beats an ambitious one that erodes.
Questions we are asked about implant revision & salvage
My implant stopped working. Does the whole device need replacing?
Not always. If the implant is recent and a single component has failed, that component can be exchanged. Once a device is beyond about eight to ten years, we normally recommend replacing all of it — the remaining parts are approaching the end of their service life, and a second operation for the sake of an old pump is a poor trade.
Can you operate on an implant that another surgeon placed?
Yes. Most of our revision patients had their original surgery elsewhere, frequently in another country. We ask for the operative report and device card so that we know exactly what is inside before we start, and we will give you an honest opinion even when that opinion is that no revision is needed.
Will I lose length with revision surgery?
It depends on why you are being revised. A prompt mechanical exchange usually preserves length completely. Length is lost when corpora are left empty for months after an explant, or after an infection that caused significant scarring — which is exactly why immediate salvage is preferred wherever it is safe.
How long will I need to stay in Istanbul?
Plan on seven to nine nights, longer than a first-time implant. Revision cases need closer wound surveillance, and in infected cases we want to see culture results and a settling inflammatory picture before you fly.
Is my original device still under warranty?
Coloplast and Boston Scientific both operate device warranty and replacement programmes, and the terms depend on the model and implant date. Send us your device card and we will tell you what applies. A warranty replacement device materially reduces the cost of revision.
Clinically reviewed by the Santa Urology surgical team. This page describes typical outcomes reported in the surgical literature and in our own practice; individual results vary and nothing here is a substitute for a personal consultation. See our medical disclaimer.