Inadequate distal support of the glans after penile prosthesis placement can result in a ventral deflection of the glans. This phenomenon, first described by Ball in 1980 [1], is commonly referred to as the supersonic transporter (SST) deformity for its resemblance to an aircraft’s drooping nose. Such glans hypermobility (or “floppy glans”) is a recognized complication following penile prosthesis implantation that can lead to cosmetic and functional issues, including sexual dissatisfaction, pain, and device erosion (reported incidence ~0.04–10%) [2]. Glanulopexy (surgical fixation of the glans to the corpora) has been utilized to correct this deformity and restore normal alignment. Here, we present a case of malleable penile prosthesis implantation in which a modified glanulopexy was performed to correct SST deformity.

This video abstract details the case of a 71-year-old male with a history of diabetes mellitus and erectile dysfunction who underwent insertion of a 13 mm Zephyr malleable penile prosthesis. Intraoperatively, marked glans hypermobility was noted, manifesting as an SST deformity with the glans misaligned ventrally relative to the shaft. A modified glanulopexy was performed to anchor the glans to the underlying corpora, thereby correcting the misalignment. Unlike traditional glanulopexy, this technique did not involve dissection around Buck’s fascia but instead relied on dartos reinforcement, reinforcing glans stability with dartos anchoring sutures.

The patient was discharged on postoperative day 1 with instructions to avoid sexual activity for four weeks. Postoperative examination demonstrated that the glans was properly aligned with the shaft, with resolution of the SST deformity. The patient’s recovery was uneventful. At the six-week follow-up, he reported normal healing with no pain, infection, or other complications. The malleable prosthesis was functioning well, and the patient expressed satisfaction with the outcome.

This case demonstrates that performing a glanulopexy at the time of penile prosthesis implantation can effectively correct SST deformity, improving anatomical alignment and potentially enhancing overall outcomes. Early correction of glans hypermobility may help prevent cosmetic and functional complications, leading to better patient satisfaction. The modified glanulopexy technique adds minimal morbidity and should be considered in patients with significant glans hypermobility to optimize prosthetic results.

Ball, T. P. Surgical repair of penile ‘SST’ deformity. Urology 15, 603–604 (1980).
Wilson, S. K., Parker, J., Carrion, R. & Simhan, J. Distortion of the implanted penis: SST and cylinder crossover. Int J Impot Res 33, 278–285 (2021).