Floppy Glans Syndrome: Pathogenesis and Treatment

Abstract Introduction Floppy glans syndrome (FGS) is a potential complication of penile prosthesis placement in patients with erectile dysfunction. FGS affects a very small proportion of these patients, and it can manifest in a ventral, dorsal, or lateral droop of a hypermobile glans, which can cause affected patients to complain of painful, unsatisfying, or otherwise difficult attempts at sexual intercourse. Incorrect cylinder sizing can even result in extreme conditions such as flail penis or S-shaped deformity. Aim The aim of this review is to outline the types, causes, and management options for FGS. Methods This review was conducted after a thorough literature search in addition to experience managing FGS at the authors' institution. Main Outcome Measures Clarification of the nomenclature for FGS, supersonic transporter deformity, flail penis, and crossover to define, diagnose, and treat these conditions. Results In many cases of FGS, poor intraoperative prosthetic cylinder positioning and sizing can lead to insufficient compression of the deep dorsal and circumflex veins between the Buck fascia and the corpora cavernosa, even when cylinders are maximally inflated. When the adjacent tissue does not adequately restrict blood flow through these vessels, then glanular tumescence becomes increasingly difficult to achieve, particularly in patients with severe erectile dysfunction who have poor glanular blood flow at baseline. FGS also can be a result of poor underlying glanular structural support. Thus, droop is possible even when cylinders have an appropriate size and position. Treatment options range from medical management to surgical correction. Distal penoplasty and glanulopexy have been described as effective methods of correcting the FGS deformity and avoiding the more invasive option of prosthetic cylinder replacement. These options are especially valuable in patients who undergo adequate cylinder sizing intraoperatively. Conclusion FGS is not monolithic, and careful diagnosis is essential to determining the appropriate treatment course.