فن إعادة الجراحة: فهم جراحة مراجعة زراعة القضيب

آخر تحديث: أغسطس 15, 2026

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A penile implant is one of the greatest quality-of-life advances in men’s health, with high satisfaction rates. But like any device placed inside the body, it can shift, malfunction or run into trouble years down the road. When that happens, fixing it is its own discipline — it takes a surgeon who is part mechanic and part detective.

في اجتماع الجمعية الأمريكية للمسالك البولية (AUA) 2026 في واشنطن العاصمة، أثناء المراقبة البروفيسور موهيت كيرا — a global leader in men’s health — I sat in on one of the most practical sessions of the conference: a panel of six experienced surgeons discussing what happens when a penile implant needs a redo. Here are the most useful lessons from it, in plain English — including the ones that are less comfortable than the case stories.

First, Why Would an Implant Ever Need Revision?

A standard penile implant has three hidden parts: two cylinders inside the penis, a small pump in the scrotum, and a fluid reservoir tucked deep in the pelvis. Most implants work well for many years. But a part can wear out, a component can shift position, or the surrounding tissue can change — and that is when a revision may be needed. Many of these problems can be corrected. Not all of them, and the honest version of that sentence comes later on this page.

Lesson 1: The Mystery of the Wandering Reservoir

One memorable case involved a man who suddenly noticed a painless bulge in his scrotum, and his previously well-functioning implant stopped working. During surgery the team found a surprise: an old, abandoned reservoir from a previous implant had drifted down into the scrotum.

Here is the background. In the past, when an old implant failed, some surgeons would leave the old reservoir in place rather than dig it out of scar tissue, and put a new one elsewhere. Usually these abandoned parts stay put. But sometimes — after heavy coughing, straining or lifting — they slip out of position and migrate. The lesson the panel emphasised: you cannot simply push it back. The surgeon must identify which part belongs to the working device, remove the leftover hardware, and secure the functional reservoir in a stable new position.

Lesson 2: Operating on Scar Tissue Is a Different Game

Every time a surgeon operates, the body forms scar tissue around the implant. In a man who has never had surgery before, the tissue is soft and predictable. In a revision it is thick, stiff and far less forgiving.

This changes everything. The tougher, less elastic tissue means incisions must be closed with especially careful stitching so the device stays securely in place. And because scarred tissue heals more slowly, men having a revision are usually asked to wait longer before using the device for the first time than a first-time patient would.

Lesson 3: Sometimes the Device Is Fine

Not every complaint means a broken device. One insightful case involved a man a few months after a technically perfect implant operation. The device was symmetric, well-positioned, and inflated and deflated flawlessly in the clinic — yet he was distressed, struggling to achieve a firm enough erection for intimacy.

The culprit was under-inflation. Many men, afraid of hurting themselves or damaging the device, do not pump it firmly enough. They squeeze three or four times, feel some resistance, and assume that is as hard as it gets. A modern implant can safely take considerably more, and reaching full rigidity often takes many more squeezes than people expect.

Two important limits on that advice, because it is the part of this article most likely to be acted on at home. First, it applies only after the activation visit, once you have been taught to use the device — usually four to six weeks after surgery. Using the pump before then risks damaging or displacing the implant. Second, pumping should not hurt. Pain on inflation, a device that will not inflate, or new asymmetry appearing as it fills are reasons to stop and be examined, not reasons to push harder. Forcing a device that has a mechanical problem is how a small problem becomes a bigger one.

With those caveats, the panel suggested a simple, non-surgical checklist before anyone considers a redo:

• An in-office demonstration: The doctor watches the patient use the device and counts the squeezes with him, often showing that it can be pumped considerably further than he realised. That moment is very common.
• Looking at the anatomy: Fat over the pubic area can drape across the base of the penis and conceal part of the shaft, shortening its usable length even when the implant is fully firm. Weight loss can help here; so, sometimes, can a minor procedure.
• Practical advice on positions: Where anatomy is the issue, this alone can solve the problem without any surgery.

Lesson 4: When a Cylinder Drifts Out of Place

The cylinders are meant to rest neatly under the head of the penis. Occasionally a cylinder tip drifts to the side or pushes inward, causing visible asymmetry or deformity. Even without pain this usually needs correction, because uneven pressure can eventually cause discomfort or tissue problems.

A useful pearl came from a senior surgeon in the audience, with one rule: get an MRI before revision surgery for a misplaced cylinder. Inside a scarred, previously operated penis you cannot rely on touch alone. An MRI shows where the old cylinder travelled, where the true chamber lies, and where healthy tissue ends. Going in with a map beats going in blind.

Worth knowing, since it worries people: having a penile implant does not prevent you from having an MRI. These devices are compatible with MRI scanning. What matters is that you tell the radiographer and the radiologist that you have one, before the scan — which is the same rule that applies before any operation, any X-ray, and any attempt to pass a urinary catheter. Keep the device identification card you were given, and show it.

When a cylinder needs repositioning, surgeons can rebuild and reinforce the chamber, and anchor the cylinder tip so it does not slip again. The panel debated which device handles these repairs best when the tissue is weakened — a reminder that experienced surgeons weigh these details case by case rather than by brand loyalty. How the devices differ is covered separately.

Lesson 5: The Most Complex Cases Need a Whole Team

The final case was a real test: a man with a complicated medical history including organ transplants, who had suffered a serious injury and significant deformity of a previous implant. His situation showed that revision surgery is never just about the penis — it is about the whole person.

Because he was on lifelong anti-rejection medication that impairs healing and raises infection risk, the surgeon’s first step was not picking up a scalpel but picking up the phone to the transplant team. The panel was emphatic: in a high-risk patient you work alongside the other specialists, timing and adjusting medication to give the body its best chance. If the transplant team is not comfortable, the surgery waits. The same principle applies to a man on anticoagulation, which is covered in penile implants and blood thinners.

What Revision Costs You That the First Operation Did Not

Case stories are encouraging, and encouragement without the other half is not much use to a man deciding what to do. Three things are true about a redo that are not true about a first implant.

• The infection risk is higher. Revision surgery carries a greater risk of device infection than the original operation, and infection is the one complication that often cannot be fixed by fixing: if the device becomes infected, the whole prosthesis usually has to come out, with a replacement at a second operation. Fifty years of work has gone into reducing that risk, and it has not been eliminated.
• Length is harder to preserve. Scarring inside the chambers can mean a slightly smaller device the second time. Where a device was removed and replacement delayed, the chambers contract, and that loss is difficult to recover — which is exactly why washing out and replacing in the same operation was such an advance.
• The result may be good rather than perfect. Correcting a deformity in scarred tissue is not the same as starting fresh. A realistic goal is a device that works comfortably and reliably, not a return to the first implant’s appearance.

What Should Not Wait

Most implant problems are not urgent, and can be sorted out at a routine appointment. These are the exceptions, and they should be reported the same day rather than saved for the next visit:

• A device that will not deflate — an erection that will not go down needs attention, not patience
• Pain that is new, worsening or persistent, rather than settling
• Fever or chills, spreading redness, or discharge from a wound or from the skin over the device
• Any part of the device becoming visible or breaking through the skin — this is erosion and needs urgent assessment
• Inability to pass urine
• A scrotum that becomes tense or enlarges rapidly

And the one people miss: an implant infection can appear months after the operation, as pain that never quite settles rather than a dramatic fever. Reporting that early is often what decides whether the device can be saved.

The Real Takeaway: Revision Is a Restoration

Watching six experienced surgeons work through these cases, one thing stood out. In textbooks, surgery looks like clean lines and perfect outcomes. Real life is messier — bodies cough, tissues scar, accidents happen, devices shift. The mark of an expert is not only placing an implant well the first time. It is having the judgement and the versatility to step into a complex, scarred situation and rebuild it into something that works.

If you have an implant that is not working the way it should, the most useful thing to know is that a great many of these problems are solved without surgery at all — and that the ones that do need surgery are best handled by someone who does them regularly.

If you have a penile implant that is not working as it should, or questions about implant surgery and revision options, Dr. Soarawee Weerasopone consults in men’s health and prosthetic urology at مقر مستشفى بانكوك and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

تتوفر خدمة الرعاية الصحية عن بعد من مستشفى بانكوك للمرضى غير القادرين على الحضور شخصياً، بما في ذلك المرضى الدوليين - يرجى ترتيب ذلك مسبقاً عن طريق البريد الإلكتروني مع قسم المسالك البولية على bhquro@bdms.co.th. It suits a first discussion and reviewing what device you have and what has happened so far; examining the device and any revision require an in-person visit. Samitivej Sriracha is in-person only.

الأسئلة المتكررة

لماذا قد يحتاج زرع القضيب إلى جراحة تصحيحية؟

Most penile implants work well for many years, but occasionally a revision is needed. Common reasons include a part wearing out or leaking, a component such as the reservoir or a cylinder shifting out of position, scar tissue affecting function, or infection. Many of these can be corrected, though infection is the one that usually requires the whole device to be removed and replaced at a second operation.

My implant does not feel firm enough — is it broken?

Not necessarily. A common reason for a soft result with a working implant is under-inflation, because many men do not pump the device firmly enough for fear of damaging it. A modern implant can safely take more, and full rigidity often needs more squeezes than expected. Two limits apply: do not use the pump at all before your activation visit, and pumping should not hurt. Pain on inflation, a device that will not inflate, or new asymmetry as it fills mean you should be examined rather than push harder.

هل جراحة المراجعة أصعب من عملية الزرع الأولى؟

Yes. Previous surgery creates scar tissue that is thicker and less elastic, making the operation more demanding and requiring extra care with closure and healing. Patients undergoing a revision are usually asked to wait longer before using the device. Revision also carries a higher risk of infection than the first operation, and scarring can mean a slightly smaller device and less length than before.

Can I have an MRI if I have a penile implant?

Yes. Penile prostheses are compatible with MRI scanning. Tell the radiographer and radiologist that you have an implant before the scan, and keep the device identification card you were given. The same applies before any operation, X-ray, or attempt to pass a urinary catheter — a catheter in particular should not be passed by someone who does not know the device is there.

Why is an MRI sometimes recommended before revision surgery?

In a previously operated penis, scar tissue makes it impossible to rely on touch alone. An MRI provides an anatomical road map, showing where an old cylinder travelled, where the true chamber is, and where healthy tissue begins and ends. This improves safety and precision and lets the surgeon plan every step before making the first incision.

What implant problems need to be seen the same day?

A device that will not deflate; new, worsening or persistent pain; fever or chills, spreading redness or discharge; any part of the device becoming visible; inability to pass urine; or a scrotum that becomes tense or enlarges rapidly. An implant infection can also appear months after surgery as pain that never quite settles, and reporting it early often decides whether the device can be saved.

What makes a good surgeon for penile implant revision?

Revision requires experience working in scarred, complex anatomy. A good revision surgeon does these procedures regularly, uses imaging when needed, knows the strengths of different devices, and coordinates with other specialists for medically complex patients — including being willing to postpone the operation when another team is not comfortable proceeding.

Disclosure: Dr. Soarawee Weerasopone has received travel and accommodation support from Boston Scientific for prosthetic surgery training workshops. He receives no payment from any manufacturer for this article, and device selection for patients is based on clinical factors.

إخلاء مسؤولية: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No advice, diagnosis or prescription is given through personal messaging channels or social media. Always consult a qualified healthcare professional before making any treatment decision. If your device will not deflate, or you develop fever, spreading redness or any exposure of the device, seek same-day medical care rather than waiting for an appointment.