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Revision Scenarios in Penile Prosthesis Surgery

Revision surgery accounts for roughly 10–20% of prosthetic urology volume at high-volume centers and carries a materially different risk profile than primary implantation: higher infection rates (3–13%), higher mechanical complication rates, longer operative times, and steeper outcomes gradient with surgeon volume.[1][2] Prior IPP infection is the single largest patient-level risk factor for subsequent infection (OR ~4.7).[3]

This article covers the anatomic and mechanical scenarios that bring a patient back to the OR: corporal scarring and fibrosis, crural crossover, corporal perforation, residual / curved erection, SST (supersonic transit) deformity, pump complications, reservoir complications, and the modified-Mulcahy salvage washout. Infection-specific management is covered in detail in the infection article.

Corporal Scarring / Fibrosis​

Corporal fibrosis — scar obliterating the intracorporal erectile-tissue planes — is the single most difficult problem in prosthetic urology. Cylinder insertion into a scarred corpus is best done by high-volume implanters with the full armamentarium of cavernotomes and narrow-base cylinders available.[12]

Causes​

Most severe fibrosis requiring specialized technique follows prior device explantation for infection (≈40–67%) and ischemic priapism (≈16–33%); the remainder is prior shunt surgery, penile trauma or urethroplasty with corporal exposure, severe Peyronie's, long-term injection therapy, or idiopathic.[13][14]

  • Prior device explantation for infection — the most severe fibrosis
  • Ischemic priapism >36 hours — progressive fibrosis begins within days
  • Prior penile shunt surgery (distal or proximal shunts)
  • Prior penile trauma, prior urethroplasty with corporal exposure
  • Severe Peyronie's with dense plaques spanning the entire corpus
  • Long-term intracavernosal injection therapy

Preoperative optimization — vacuum erection device protocol​

Levine's group (Tsambarlis 2017) described a preoperative VED protocol — 10–15 minutes at least twice daily for ≥3 months — that softens fibrotic tissue before surgery. In 13 men with severe fibrosis, all underwent successful three-piece IPP placement with standard-size cylinders without additional maneuvers, and stretched flaccid length increased a mean of 0.92 cm. Tissue rehabilitation is strongly worth considering before operating on a fibrotic corpus.[15]

Stepwise intraoperative escalation​

No single algorithm is universal; escalate by the degree of fibrosis encountered.[16][17]

  1. Sequential Hegar dilation (8–12 mm) — first-line, and the sole technique needed in ~36% of fibrosis cases in a multicenter series.[13]
  2. Cutting cavernotomes — when standard dilators meet resistance, cavernotomes core out scar with controlled ~1 mm oscillating cuts, cutting edge aimed laterally, away from the urethra; the most commonly employed technique (~60% of cases).[13][18][19] The main families:
CavernotomeDesignBest for
MoorevilleBlunt-tipped, sharpened lateral edges; 6–13 mm setModerate fibrosis; the workhorse cavernotome[18]
GhanemTapered cutting tip with graduated sizesSevere fibrosis; full corporal length
UramixRetractable cutting elementSelective cutting; user-controlled
Carrión-RosselloOpen-tipped with progressive sharpeningVariant of Mooreville concept

Creating the starter channel. In a corpus with no developable plane, a cavernotome cannot simply be inserted — a channel must first be carved. The Wilson backward-cutting scissors (Freeman-Kaye / Gourney pattern, supplied by Uramix) are the dedicated tool: their outer blade edges are sharpened, so they cut not only on closing but when spread open inside scar, opening the initial space to seat a cavernotome. The cavernotomes then enlarge it — the Rossello-Carrión with a backward-cutting rasp that resects on withdrawal, the Mooreville with a 1 mm blade advanced by rotation.[18][27]

  1. Corporal counter incisions — distal or proximal incisions through the tunica albuginea add access and visualization when dilation from the corporotomy alone is insufficient.[16][17]
  2. Corporeal excavation (Montague–Angermeier) — for severe diffuse fibrosis, an inverted-T penoscrotal incision exposes nearly the entire corpus bilaterally. Extended ventral corporotomies develop a plane between scar and inner tunica, allowing core removal of nearly all intracorporal scar; cylinders then lie in the empty corporal bed and the tunica is closed primarily — no graft required. All 9 patients in the original series had successful outcomes.[20]
  3. Corporal reconstruction with grafting — when scar excision leaves a tunical defect that will not close primarily, pericardium, dermis, or synthetic graft reconstructs the corporal body. Sansalone reported simultaneous total corporal reconstruction plus implantation in 18 patients, at higher complication rates than virgin cases.[21]

The Carter-Trost approach is the named variant of the open ventral-corporotomy strategy: a longitudinal ventral corporotomy from proximal to distal opens the corpus for dilation under direct vision, then closes over the cylinder — converting a blind dilation problem into an open-dissection one, particularly useful after prior infection explantation.[4]

Cylinder selection in the fibrotic corpus​

Narrow-base cylinders are the key device tool when full dilation cannot be achieved. Standard cylinders require ≥12 mm of corporal dilation; narrow-base devices (AMS 700 CXR, Coloplast Titan Narrow Base) require only 10 mm.[19][22]

  • AMS 700 CXR accounted for 5% of IPPs at one high-volume center — indications prior explant for infection (67.3%), ischemic priapism (16.3%), idiopathic fibrosis (16.3%); discordant intraoperative corporal measurements common (24.5%); complications higher than virgin cases (16.3% — infection 6.1%, herniation 4.1%, mechanical failure 4.1%); 73.5% satisfied with rigidity, though length/girth dissatisfaction was common.[14]
  • Staged upsizing (Wilson 2006) — downsized cylinders double as tissue expanders: the patient inflates up to 3 h/day and, after 8–12 months, the corporal space has expanded enough to reoperate and replace with standard cylinders. All 37 patients were upsized successfully; mean corporal length increased 2.2 cm in post-infection patients.[23]

Single (unilateral) cylinder placement​

Bilateral cylinders are the universal standard for axial rigidity; unilateral placement is never planned — only a salvage decision.[24] A single cylinder may be placed when:

  • One corpus is completely obliterated (unilateral shunt, asymmetric infection, trauma) and cannot be dilated despite all techniques — a cylinder is placed on the functional side only.[12]
  • An unrepairable unilateral complication occurs (urethral injury, distal perforation, crossover) — place the contralateral cylinder rather than abort the case.[25]
  • Neophallus / phalloplasty anatomy — some constructions create a single neocorporal channel that accepts only one device (often a malleable or semi-rigid implant).[26]

When to abort and place a malleable​

Fibrosis severe enough that the corpus cannot be safely dilated to accommodate an inflatable cylinder is an indication to place a malleable prosthesis instead. Coloplast Tactra, AMS Spectra, or Rigicon Rigi10 are routinely used in this scenario. Switching from an intended inflatable to a malleable mid-case is a judgment call that experienced prosthetic urologists make without hesitation — forcing an inflatable into a corpus too fibrotic for the expansion produces poor outcomes.[26]

Length preservation​

Fibrosis and time from priapism both reduce corporal length. In the priapism patient, the 2019 Yafi consensus recommends early implantation (within 4–6 weeks of the priapism event) to preserve length — with the recognition that infection risk is higher on a recently inflamed corpus.[5] The alternative — delaying for months while fibrosis consolidates — progressively shortens the achievable cylinder length.

Technique selection at a glance​

TechniqueWhen to useKey detail
Preoperative VEDAll fibrosis cases (planned)10–15 min BID × ≥3 mo; may permit standard cylinders
Sequential Hegar dilationFirst-line intraoperativeStandard dilators 8–12 mm
Cutting cavernotomesDilators meet resistanceAim cutting edge laterally; 6–13 mm
Counter incisionsInadequate access from corporotomyDistal/proximal tunical incisions
Corporeal excavationSevere diffuse fibrosisInverted-T incision; core out scar; no graft
Reconstruction + graftingTunical defect after excisionPericardium, dermis, or synthetic graft
Narrow-base cylindersCannot dilate to 12 mmCXR / Titan NB need only 10 mm
Staged upsizingAfter downsized placementInflate 3 h/day × 8–12 mo, then reoperate
Malleable conversionCorpus too fibrotic for inflatableMid-case judgment call
Unilateral cylinderOne corpus unsalvageable / unrepairable injurySalvage only — never planned

Crural Crossover​

Definition​

During corporal dilation, the dilator perforates the medial septum between the two corpora cavernosa and crosses into the contralateral corpus. A cylinder placed down this false tract sits in the wrong corpus and produces curvature, asymmetric inflation, and potential urethral injury.

Recognition​

  • The dilator feels "soft" and encounters less resistance than expected
  • Bilateral corporal measurements diverge despite apparently identical dilation
  • On test inflation, the penis deviates to one side or appears bowed
  • The cylinder tip position differs side to side on palpation

Management​

  • Recognize before cylinder placement — always confirm the dilator track by palpating the corpus from outside during dilation
  • If crossover is identified, redirect the dilator laterally and reestablish the correct track; many surgeons use a narrower dilator to find the true plane before re-dilating
  • If a cylinder has already been placed down the wrong track and crossover is suspected postop, reoperation is required
  • The Mulcahy windsock technique — placement of a synthetic graft (Dacron sleeve or GoreTex windsock) around the proximal cylinder to prevent proximal migration — is used when crural perforation has occurred or is anticipated in a friable corpus

Corporal Perforation​

Where it happens​

  • Distal perforation — through the glans or subcoronal tunica into the subcutaneous tissue
  • Proximal perforation — through the crural tunica into the perineum or ischioanal fossa
  • Urethral perforation — through the medial tunica into the urethra; the most consequential perforation

Recognition​

  • Hematuria — immediate concern for urethral injury; confirms with retrograde urethrogram or direct cystoscopy
  • Dilator or Keith needle entering a non-corporal space — recognized by the feel of the tip
  • Bleeding out of proportion to the expected corporotomy bleeding

Management​

  • Urethral perforation: abort the implant. The device cannot be placed over an open urethral injury. Repair the urethra primarily, leave a Foley 10–14 days, and delay reimplantation by at least 6 weeks (many prefer 3 months).
  • Tunica perforation (distal or proximal): if a synthetic-sleeve (Mulcahy windsock) can contain the cylinder within the intended plane, the case can often be completed. If not, abort and return.
  • Distal perforation into the glans — a known but rare complication; sometimes salvageable with careful distal cylinder tip repositioning and suture repair of the glans tunic; glans necrosis is a feared downstream complication.

See complications for the broader complication framework.

Residual / Curved Erection​

Persistent curvature after a Peyronie's-with-ED implant is a common revision scenario. Causes include:

  • Residual tunical plaque — not addressed or incompletely addressed at implant
  • Asymmetric cylinder length
  • Asymmetric RTE selection mimicking length difference
  • Pump or reservoir positioning causing traction on one side

Management​

  • Intraoperative modeling — gentle manual bending of the fully inflated cylinders against the concavity to mechanically stretch the tunical plaque; most curvatures <30° respond
  • Plication — addition of tunical-albuginea plication sutures on the convex side to correct residual curvature
  • Tunical incision and grafting — for severe residual curvature, formal tunica albuginea incision with graft (dermis, bovine pericardium, SIS, or synthetic) is indicated; this can be done at the primary implant (via subcoronal approach) or at revision

The subcoronal approach at revision​

When the original case was penoscrotal or infrapubic and severe residual curvature requires formal grafting, converting to subcoronal at revision provides the exposure needed. This is a more demanding operation than either primary and benefits from co-surgery with an experienced subcoronal implanter.

SST (Supersonic Transit) Deformity​

Definition​

"SST" or "supersonic transit" deformity refers to a drooping, floppy glans that sits forward of the inflated cylinders when the device is erect. The distal cylinder tip fails to extend into the glans, and the glans hangs passively off the end of the shaft.[6]

Mechanism​

  • Cylinder too short for the distal corpus — the most common cause
  • Underdilation of the distal corpus — the cylinder sits shy of the subcoronal recess
  • Chronic distal corporal fibrosis preventing full expansion
  • Glans atrophy from prior surgery, aging, or hypogonadism

Management​

  • Upsize the cylinder if revision is planned — longer cylinder + appropriate RTE
  • Redilate the distal corpus to the subcoronal recess
  • Glanular support plication — suturing the glans to the cylinder tips with permanent suture through the tunica albuginea to pull the glans forward and onto the cylinder
  • Tunica albuginea–to–glans suturing — the "glans fixation" technique for persistent SST

Prevention​

  • Adequate distal dilation at primary implant
  • Appropriate cylinder length — always re-measure before final selection
  • Recognition that SST is more common in older patients, diabetic patients, and those with prior distal corporal surgery

Pump Complications​

Malposition (high-riding pump, low-riding pump)​

High-riding pump — pump retracts into the superficial inguinal region where the patient cannot reach it for cycling. Causes: inadequate scrotal pocket; scrotal retraction with age; tethering of pump tubing to overlying dartos.

Low-riding pump — pump sits low against the testis, uncomfortable and occasionally visible. Causes: overly dependent pocket; loss of scrotal tone.

Management: revision with pump repositioning. Re-tunneling of the dartos pocket; consideration of tacking sutures to hold the pump in position (controversial — some surgeons argue tacking increases infection risk).

Pump erosion​

Rare in primary cases but increases with revision frequency, thin-scrotum patients, and in diabetic/radiated scrotal tissue. Presents as skin tenting, focal erythema, or frank erosion through the scrotal skin.

Management: explantation of the pump and associated tubing, wound care, and delayed reimplantation.

Pump malfunction​

Mechanical failure of the pump mechanism (valve failure, deflation valve sticking). The 3-piece IPP has a long mechanical life, but pump failure rates rise after 10–15 years.

Management: isolated pump replacement (with intraoperative pressure testing of cylinders and reservoir to confirm they are intact), or complete device exchange.

Reservoir Complications​

Covered in detail in reservoir placement. Revision-specific scenarios:

  • Reservoir herniation into the scrotum — revision with relocation to HSM
  • Reservoir autoinflation — revision with pocket enlargement or relocation; modern lock-out valves have reduced this incidence
  • Reservoir bladder erosion — reservoir explantation, cystorrhaphy, delayed reimplantation
  • Retained reservoir after prior infection explantation — imaging (CT or MRI) to localize; open retrieval at time of reimplantation if accessible

Drain and Retain​

When a functioning revision requires a new reservoir but the old one has become densely adherent in the space of Retzius, formal explantation can be more morbid than the revision itself. The "drain and retain" maneuver sidesteps this: the existing reservoir is emptied and intentionally left in situ rather than dissected free, and a new reservoir is placed — typically on the contralateral side.[9][10] The same principle applies to the AUS pressure-regulating balloon (see artificial urinary sphincter — PRB modification).

Technique: aspirate all fluid from the reservoir to defunctionalize it, place the tubing on traction, and transect the tubing proximally to disconnect it from the rest of the system. The collapsed reservoir is left behind as an inert foreign body; a new reservoir is sited fresh (HSM or contralateral space of Retzius).[9]

Rationale: an encapsulated reservoir in the space of Retzius can be densely adherent to the bladder, iliac vessels, obturator nerve, or bowel. Dissecting it out risks exactly those injuries; draining-and-retaining avoids the retropubic dissection while still allowing a functional new reservoir.[9][10]

Safety data:

  • Cefalu et al. (2013) — original single-surgeon series of 55 drain-and-retain cases over 5 years. Infection rates were comparable to virgin implants (1.8% vs 1.5%, p = 0.88), with no complications attributable to the retained balloon/reservoir.[9]
  • Pereira et al. (2026) — largest multi-institutional review to date: 233 revision cases across 7 high-volume centers (112 drain-and-retain vs 121 complete removal). At a mean 12.6-month follow-up there were no complications attributed to retained reservoirs and no significant differences in postoperative infection (p = 0.940), device malfunction (p = 0.674), or symptomatic migration of the new reservoir (p = 0.955).[10]

Caveats:

  • Contraindicated when the device is being explanted for infection — a retained reservoir could serve as a nidus for persistent or recurrent infection.[9][10]
  • Long-term outcomes are unknown — the largest series has a mean follow-up of only ~12.6 months, and the practice remains debated given the risk of retained foreign material.[10] Loloi et al. (2022) reported two cases of drained-and-retained reservoirs (one IPP, one AUS — the latter the first such AUS report) presenting later as small bowel obstruction, the migrated balloon acting as a lead point; the risk is greatest with intraperitoneal reservoir position. Confirm the retained reservoir is extraperitoneal, and counsel the patient that a retained reservoir can become symptomatic years later.[11]

The Modified-Mulcahy Salvage Washout​

For infected IPP — when the surgeon judges the infection is not extensive tissue erosion or systemic and the patient is a salvage candidate — immediate washout and replacement is offered as an alternative to explantation + delayed reimplantation. The modified protocol:[7][8]

  1. Explant all components — cylinders, pump, reservoir, tubing.
  2. Culture — capsule, pseudocapsule, fluid — with next-generation sequencing where available.
  3. Sequential antiseptic washes — vancomycin-gentamicin saline; avoid hydrogen peroxide (cytotoxic, air embolism risk) and avoid excessive betadine (cytotoxic, infection-promoting).
  4. Change all gloves and instruments after explantation and wash steps.
  5. Re-prep and re-drape the field with fresh Ioban.
  6. Place a new antibiotic-coated device — typically the same manufacturer as explanted, or the contralateral manufacturer per surgeon preference.
  7. Add antifungal coverage — routine in salvage settings.
  8. Avoid 0.05% CHG if the new device is hydrophilic Titan.
  9. Close; postoperative antibiotic course per institutional protocol (though emerging data suggest shorter courses).

Salvage success rates in experienced hands: approximately 80–90% at 1 year. Lower in radiated tissue, in patients with severe systemic inflammation, and in those with tissue erosion.

When to explant without replacement​

  • Tissue erosion (cylinder through glans or urethra; pump through scrotum; reservoir through bladder)
  • Sepsis or SIRS physiology
  • Uncontrolled diabetes or acute metabolic derangement
  • Patient instability precluding longer OR time

In these scenarios: explant, delayed reimplantation at 3–6 months after infection clearance.

Unique consent elements for revision patients:

  • Baseline higher infection risk — 3–13% in revision vs. 1–3% in primary
  • Shorter penis after revision — cumulative length loss with each operation
  • Higher mechanical complication rate for the revised device
  • Possibility of intraoperative conversion (3-piece → 2-piece → malleable) based on anatomic findings
  • Possibility of abort if corporal or urethral injury occurs

Documentation is especially important here — medicolegal exposure on revision patients is materially higher than on primaries.

See Also​

References​

1. Henry GD, Wilson SK, Delk JR 2nd, et al. Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study. J Urol. 2005;173(1):89–92. doi:10.1097/01.ju.0000146717.62215.6f

2. Cocci A, Capogrosso P, Minhas S, et al. Penile prosthesis implantation: a systematic review of intraoperative and postoperative complications. Int J Impot Res. 2025. doi:10.1038/s41443-025-01108-4

3. Abou Chawareb E, Hammad MAM, Azad B, et al. Perioperative antimicrobial strategies in inflatable penile prosthesis surgery. J Urol. 2025;214(6):642–653. doi:10.1097/JU.0000000000004716

4. Carrion H, Martinez D, Parker J, et al. A history of the penile prosthesis. J Sex Med. 2016;13(10):1522–1527. doi:10.1016/j.jsxm.2016.07.002

5. Yafi FA, Hatzichristodoulou G, April Y, et al. Review of management options for patients with atypical priapism. Sex Med Rev. 2015;3(2):103–118. doi:10.1002/smrj.44

6. Ball TP Jr. Surgical repair of penile "SST" deformity. Urology. 1980;15(6):603–4. doi:10.1016/0090-4295(80)90381-x

7. Mulcahy JJ. Long-term experience with salvage of infected penile implants. J Urol. 2000;163(2):481–2. doi:10.1016/s0022-5347(05)67906-2

8. Razdan S, Siegal AR, Celtik KE, Carrion R, Valenzuela RJ. Three-piece penile prosthesis salvage with chlorhexidine gluconate and length preservation: our technique and outcomes. Asian J Androl. 2026;28(1):9–15.

9. Cefalu CA, Deng X, Zhao LC, et al. Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013;82(6):1436–9. doi:10.1016/j.urology.2013.07.038

10. Pereira TA, Good J, Rust JO, et al. Early clinical outcomes of the "drain and retain" maneuver in inflatable penile prosthesis revision surgery: a multi-institutional review. J Sex Med. 2026;23(3):qdag024. doi:10.1093/jsxmed/qdag024

11. Loloi J, Davila J, Babar M, et al. Case series — small bowel obstruction secondary to retained male urinary and sexual prostheses reservoirs. Can Urol Assoc J. 2022;16(7):E403–E405. doi:10.5489/cuaj.7773

12. Wilson SK, Simhan J, Gross MS. Cylinder insertion into scarred corporal bodies: prosthetic urology's most difficult challenge: some suggestions for making the surgery easier. Int J Impot Res. 2020;32(5):483–494. doi:10.1038/s41443-020-0282-0

13. Krughoff K, Bearelly P, Apoj M, 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

14. Johnson BE, Langford BT, VanDyke ME, et al. Long-term experience with AMS-700 CXR inflatable penile prosthesis in high-risk patients with corporal fibrosis. Int J Impot Res. 2025;37(1):66–71. doi:10.1038/s41443-024-00962-y

15. Tsambarlis PN, Chaus F, Levine LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med. 2017;14(1):44–46. doi:10.1016/j.jsxm.2016.11.304

16. Trost L, Patil M, Kramer A. Critical appraisal and review of management strategies for severe fibrosis during penile implant surgery. J Sex Med. 2015;12(Suppl 7):439–47. doi:10.1111/jsm.12985

17. Martínez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med. 2011;8(7):1880–9. doi:10.1111/j.1743-6109.2011.02281.x

18. Mooreville M, Adrian S, Delk JR, Wilson SK. Implantation of inflatable penile prosthesis in patients with severe corporeal fibrosis: introduction of a new penile cavernotome. J Urol. 1999;162(6):2054–7. doi:10.1016/S0022-5347(05)68099-8

19. Clavijo RI, Sávio LF, Prakash NS, et al. Three-piece penile prosthesis implantation in refractory ischemic priapism — tips and tricks. Urology. 2017;106:233–235. doi:10.1016/j.urology.2017.04.032

20. Montague DK, Angermeier KW. Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis. Urology. 2006;67(5):1072–5. doi:10.1016/j.urology.2005.11.001

21. Sansalone S, Garaffa G, Djinovic R, et al. Simultaneous total corporal reconstruction and implantation of a penile prosthesis in patients with erectile dysfunction and severe fibrosis of the corpora cavernosa. J Sex Med. 2012;9(7):1937–44. doi:10.1111/j.1743-6109.2012.02748.x

22. Chang YK, Gillman N, Chung E. Optimizing cylinder selection in inflatable penile prosthesis surgery: a narrative review. Int J Impot Res. 2026. doi:10.1038/s41443-026-01259-y

23. Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3(4):736–742. doi:10.1111/j.1743-6109.2006.00263.x

24. Levine LA, Becher EF, Bella AJ, et al. Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine. J Sex Med. 2016;13(4):489–518. doi:10.1016/j.jsxm.2016.01.017

25. Chung E, Bettocchi C, Egydio P, 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

26. Goodstein T, Jenkins LC. A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient. Int J Impot Res. 2023;35(7):623–628. doi:10.1038/s41443-023-00765-7

27. 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