The safe and successful implantation of a penile prosthesis into a severely fibrosed corpora is one of the most technically challenging aspects of penile implant surgery. There are many techniques and special instruments described to aid a successful outcome, and surgeons undertaking such cases should have knowledge and experience of these techniques, as well as access to helpful special instrumentation, but also be prepared to be innovative intra-operatively and adapt to the pathology discovered to achieve the best outcome for that patient. This chapter of this surgical video atlas will outline and demonstrate many of the techniques that implant surgeons will need to know to undertake this, typically, complex surgery.