Revision Penile Surgery: Why the Second Operation Can Be More Complex
Having another operation on the penis does not simply mean repeating the first procedure.
Previous surgery changes the tissues. Scar tissue can develop, normal anatomical planes may be less clear, implanted material may already be present, and the blood supply or available skin may be different. For these reasons, revision penile surgery can require different planning and techniques from first-time surgery.[1-4]
This does not mean revision surgery will necessarily have a poor outcome. It means the surgeon first needs to understand what was done previously, why another operation is being considered and what the tissues are like now.
What is revision penile surgery?
Revision penile surgery is an operation performed after previous surgery to the penis or surrounding genital structures.
It may include further surgery after:
penile implant surgery
Peyronie’s disease surgery
penile reconstruction
previous infection or implant removal
circumcision or foreskin surgery
surgery for penile trauma or scarring
previous procedures that have altered penile anatomy
Some revisions are relatively limited. Others involve substantial reconstruction.
Patients with an existing penile prosthesis can read more about penile implant revision surgery, while broader reconstructive conditions are covered under Penile, Genital & Urinary Reconstruction.
Why can the second operation be more difficult?
1. Scar tissue changes the anatomy
Every operation causes some degree of healing and scar formation.
Inside the penis, significant scarring can make tissues firmer and less flexible. Scar tissue within the erectile bodies is known as corporal fibrosis. It can develop after previous implant surgery, infection, implant removal, priapism, Peyronie’s disease or other penile procedures.[3-5]
Severe corporal fibrosis can make it harder to create the space required for a penile implant and may require specialised surgical techniques. Published studies and international consensus recommendations recognise significant fibrosis as an important factor in complex penile prosthesis surgery.[3-5]
2. Normal surgical planes may no longer be obvious
During first-time surgery, tissues usually separate along predictable anatomical planes.
After previous surgery, these layers may become stuck together through fibrosis. Structures such as the urethra, erectile bodies, penile skin and surrounding tissues may therefore be more difficult to separate.
The surgeon may need to modify the incision, exposure or reconstructive plan according to what is found.
This is one reason previous operation reports can be particularly valuable before revision surgery.
3. There may already be an implant in place
Revision of an existing penile prosthesis introduces another layer of complexity.
Possible reasons for penile implant revision include:
mechanical failure
difficulty inflating or deflating the implant
pump, cylinder or reservoir positioning problems
erosion
infection
significant fibrosis
problems following previous revision surgery
Sometimes only one component appears to be causing the problem. In other circumstances, removal or replacement of more of the prosthesis may need to be considered.
Current European Association of Urology guidance identifies mechanical failure and infection as the two main complications of penile prosthesis implantation.[1]
4. Infection requires particular consideration
Infection is an important concern whenever prosthetic material is involved.
Research has demonstrated that bacteria and bacterial biofilm can sometimes be found on penile prostheses removed during revision surgery even when there were no obvious signs of clinical infection.[6]
The clinical significance varies, but it helps explain why prosthetic revision surgery requires careful infection-prevention planning.
If a penile implant is clearly infected, management commonly involves removal of infected components and antimicrobial treatment. In selected situations, removal and immediate replacement — known as salvage surgery — may be considered rather than waiting for a later reimplantation.[1,8]
Salvage is not appropriate for every patient. The decision depends on the severity of infection, the condition of the tissues and the individual clinical situation.
5. Removing an implant can lead to further fibrosis
If an infected or eroded penile implant has previously been removed, the erectile bodies can become increasingly scarred as they heal.
This fibrosis may narrow the space where replacement cylinders would normally sit and can contribute to penile shortening or make later implantation technically more difficult.[3-5]
International consensus recommendations specifically identify patients with significant fibrosis following previous infected prosthesis removal as complex cases requiring careful planning.[3]
This is why management of an infected implant is not simply a question of “remove it now and put another one in later.” The advantages and disadvantages of immediate salvage versus delayed reconstruction need to be considered individually.
What about penile length?
Concern about penile length is common before revision surgery.
Previous erectile dysfunction, Peyronie’s disease, infection, implant removal and fibrosis can all affect penile dimensions. In a heavily scarred penis, the internal space available for a prosthesis may also be different from the space available during the original operation.[3-5]
Revision surgery cannot guarantee restoration of a previous penile length.
In complex cases, the priority may be creating a safe, functional reconstruction rather than achieving a predetermined measurement. Procedures intended specifically to restore or increase length can carry additional risks and are not appropriate for every patient.
Patients concerned about curvature or shortening may also find the information on Peyronie’s disease useful.
Does revision always mean replacing everything?
No.
The appropriate operation depends on why the original surgery is being revised.
For a penile implant, possibilities may include repositioning a component, replacing selected components, exchanging the complete device, removal without immediate replacement, or infection salvage.
For other penile operations, revision might involve releasing scar tissue, correcting deformity, revising skin coverage or performing a more substantial reconstruction.
There is therefore no single operation called “penile revision surgery”.
What should be assessed before revision surgery?
Before considering another operation, it is useful to establish exactly what problem needs to be corrected.
Assessment may include reviewing:
Previous surgery. Operation reports can explain the original approach, implants used, grafts, complications and unusual anatomical findings.
Current anatomy. Examination helps determine the location of scars, penile shape, tissue quality and any evidence of erosion or infection.
Implant information. For patients with a prosthesis, the implant identification card, manufacturer, model and date of implantation can be helpful.
Current function. The specific problem — pain, curvature, implant malfunction, difficulty with intercourse, altered position or another concern — needs to be clearly defined.
Patient priorities. What matters most may differ between patients and could include rigidity, comfort, implant operation, penile shape, urinary function or correction of a particular complication.
Current international recommendations emphasise appropriate patient selection, counselling and shared decision-making when planning penile prosthesis surgery.[2,3]
Can revision penile surgery still work well?
Yes, revision surgery can provide useful outcomes in appropriately selected patients, although results depend heavily on the reason for revision and the condition of the tissues.
For example, a multicentre study of more than 200 penile prosthesis revisions reported functioning implants after revision in the large majority of the study population.[7] However, this was a selected patient group treated using a specific revision protocol, so the result should not be interpreted as a guaranteed success rate for an individual patient.
The important point is that revision surgery is not automatically unsuccessful — but it often requires more individualised planning than first-time surgery.
When should an existing penile implant be reviewed urgently?
Seek prompt medical assessment if you develop:
increasing penile or scrotal pain
redness or progressive swelling
wound discharge
fever or feeling systemically unwell
skin breakdown over an implant
part of an implant becoming visible
sudden major change in implant position
significant difficulty passing urine
These symptoms can indicate infection, erosion or another complication that should not wait for a routine review.
Planning revision penile surgery
If you have undergone previous penile surgery, bringing as much information as possible to your consultation can make planning easier.
Useful documents include previous operation reports, implant identification details, previous imaging, microbiology results and records relating to previous infection or complications.
You can explore further information on:
Penile Implant Revision Surgery
Penile, Genital & Urinary Reconstruction
Patients travelling from outside Brisbane can also review the interstate and international patient information.
Considering assessment after previous penile surgery?
If you have a problem following previous penile surgery, the first step is usually to establish what has changed and why rather than assuming another operation is required.
Previous operative records, implant details and relevant investigations can be reviewed alongside an examination to determine which management options may reasonably be considered.
References
European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction. Arnhem: EAU; 2026.
Köhler TS, Munarriz R, Parker J, Bettocchi C, Hatzichristodoulou G, Martins FE, et al. Penile prosthesis for erectile dysfunction: recommendations from the 5th International Consultation on Sexual Medicine. Sex Med Rev. 2025;13(2):144-171. doi:10.1093/sxmrev/qeaf001.
Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, et al. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol. 2022;19(9):534-546. doi:10.1038/s41585-022-00607-z.
Fernandez Crespo RE, Stroie F, Taylor L, Pignanelli M, Parker J, Carrion R. Penile fibrosis—still scarring urologists today: a narrative review. Transl Androl Urol. 2024;13(1):127-138. doi:10.21037/tau-23-206.
Krughoff K, Bearelly P, Apoj M, Munarriz NA, Thirumavalavan N, Pan S, et al. Multicenter surgical outcomes of penile prosthesis placement in patients with corporal fibrosis and review of the literature. Int J Impot Res. 2022;34(1):86-92. doi:10.1038/s41443-020-00373-9.
Nosé BD, Grimberg DCD, Lentz AC. Update on intraoperative cultures, biofilms, and modifiable factors during revision of clinically non-infected penile implants. Sex Med Rev. 2021;9(1):160-168. doi:10.1016/j.sxmr.2020.07.005.
Henry GD, Donatucci CF, Conners W, Greenfield JM, Carson CC, Wilson SK, et al. An outcomes analysis of over 200 revision surgeries for penile prosthesis implantation: a multicenter study. J Sex Med. 2012;9(1):309-315. doi:10.1111/j.1743-6109.2011.02524.x.
Swanton AR, Gross MS, Munarriz RM, Mulcahy JJ. Penile prosthesis salvage: a historical look at the Mulcahy technique and a review of the latest literature. Int J Impot Res. 2023;35(2):90-94. doi:10.1038/s41443-021-00515-7.
Medical disclaimer
This article provides general educational information only and is not a substitute for individual medical advice, diagnosis or treatment. The need for revision surgery, the type of procedure that may be appropriate, expected recovery and potential risks vary according to previous surgery, anatomy, examination findings, implants and individual medical circumstances. Not every problem following penile surgery requires another operation. Seek prompt medical assessment if you have symptoms suggesting infection, implant erosion or another acute postoperative complication.
