Ventral corporal reinforcement using a pericardium allograft (Tutoplast®) in a patient undergoing urethrectomy procedure with an inflatable penile prosthesis in place: A case report

Background: Erectile dysfunction is a common consequence following radical cystectomy (RC), with inflatable penile prostheses (IPPs) placement considered as the gold standard for refractory cases. Urethral recurrence post-RC necessitates urethrectomy, which poses challenges for patients with an IPP in place. The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting device functionality. This case report introduces a novel surgical technique using Tutoplast, a human-derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of an in-situ IPP. Methods: A 74-year-old male, with a history of robotic-assisted RC and IPP presented with recurrent bleeding per urethra. Imaging revealed urethral masses. The patient underwent total urethrectomy which resulted in significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, a Tutoplast graft was used intraoperatively to reinforce the thinned tunica. Patient was followed up six months postoperatively. Results: Final pathology showed urethral high-grade papillary urothelial carcinoma. Postoperatively, the patient exhibited smooth recovery, with normal IPP functionality up to the 6-month follow-up period. While Tutoplast has been used in other settings, its application in preventing IPP malfunction posturethrectomy is a unique contribution. Conclusion: Corporal reinforcement using Tutoplast during urethrectomy in patients with an existing IPP presents a simple and cost-effective solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms. The positive outcomes demonstrated in this case report warrant further studies on larger patient populations and longer follow-up periods to assess the long-term outcomes of this technique.