A New, Innovative, Lengthening Surgical Procedure for Peyronie’s Disease by Penile Prosthesis Implantation with Double Dorsal-Ventral Patch Graft: The “Sliding Technique”

Abstract

Introduction. Peyronie's disease is the result of the formation of fibrous plaques in the tunica albuginea of the penis; typical presentations of the disease are represented by pain during erection, erectile dysfunction, and penile deformities, such as curvature, narrowing, and penile shortening. The most complex treatment is related to penile shortening. Aim. To find a safe procedure in penile shortening due to Peyronie's disease providing a satisfactory lengthening, allowing an early stabilization of the penis, and preventing axial tension on the neurovascular bundles during dilation. Methods. We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa. Three patients, affected by Peyronie's disease with penile shortening and erectile dysfunction, underwent this procedure with approval of our local ethical committee. We evaluated the penis lengthening, intraoperative and postoperative complications, patient's preoperative and postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire).

Can Ambicor® Penile Prosthesis be Used in One Piece in Patients with Inadequate Cavernous Structure? Our Experience of Two Cases

“…Tunica albuginea incision and excision can be used in cases with serious curvature and plaque. Sliding technique, where tunical excision and grafting are performed on dorsal-ventral penis, has been described in patients whose corpus cavernosum is short and has been modified to become suitable for penile length prosthesis implantation (11). The studies on this issue in the literature are on cases that are accompanied by Peyronie's disease (11,12,13,14,15).…”

“…Sliding technique, where tunical excision and grafting are performed on dorsal-ventral penis, has been described in patients whose corpus cavernosum is short and has been modified to become suitable for penile length prosthesis implantation (11). The studies on this issue in the literature are on cases that are accompanied by Peyronie's disease (11,12,13,14,15). Peyronie's disease did not accompany in our cases, however, only one of the cylinders of the prosthesis could be implanted due to the fact that the penile length of our cases was short and the diameter of the corpus cavernosum was totally insufficient.…”

Recent surgical advances in Peyronie’s Disease

“…Two separate transverse incisions with posterior dilatation of the corpora cavernosa, the insertion of the prosthesis and added suture of two grafts seems promising, with an increase in length close to 3 cm. 62 Also Egydio and Sansalone reported a length gain of over 3 cm by performing circumferential incision and grafting with subsequent IPP placement. 63 A novel report describes preoperative traction therapy for men with a shortened penis, prior to IPP placement that may yet be another alternative to prevent shortening, with even some length gain (0.5 -2.0 cm).…”

117 Non-degloving Technique for Peyronie's Disease with Penile Prosthesis Implantation and Double Dorsal-ventral Patch Graft

“…17,18 Recent studies have demonstrated that the ST is an effective method to not only perform PP implantation but also restore length in patients with severe PD and ED. 6,7,16,19 Rolle et al 7 conducted a multicentric study on the outcomes of the ST with complete degloving of the penile shaft in 28 patients. The ST demonstrated an intraoperative straightening of all penises, an average increase of 3.2 cm in penile length, and an overall increase in patient satisfaction rate at the expense of a slight increase in complications.…”

“…6,7 This approach is generally preferred as it allows adequate exposure of the surgical site and allots space for deep corrective sutures. However, as the glans is the most distal aspect of the penis, it is susceptible to ischemic and lymphatic complications during degloving.…”