Optimizing cylinder selection in inflatable penile prosthesis surgery: a narrative review

There have been considerable advances in our scientific knowledge, surgical techniques and technological innovation for modern inflatable penile prosthesis (IPP) implants over the past 50 years. Four major device companies have successfully manufactured and marketed IPP devices worldwide, and these devices have pre-determined cylinder sizes and unique properties. It is recommended that the cavernosal body be dilated to at least 12 mm to accommodate a standard IPP cylinder and 10 mm for smaller diameter or narrow-base devices. The selection of cylinder size and type is often based on intraoperative total corporal length and dilation measurements; however, other factors such as the surgeon's expertise and preference, the presence of corporal fibrosis and/or the use of a rear-tip extender can influence the final cylinder selection. A properly sized cylinder that sits nicely within the corporal body and cycles well is the prerequisite for an optimal IPP function and a satisfied patient. This article provides a narrative review of the overview of the decision-making and common surgical challenges encountered in the selection of cylinder size and type.