A review of surgical strategies for penile prosthesis implantation in patients with Peyronie’s disease

Abstract

The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie’s disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords “penile prosthesis”, “surgical management” and “Peyronie’s disease”. Patient satisfaction rates of 72–100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients. Three-piece IPPs are most commonly used, and when comparing the two most popular models (AMS 700 CX vs. Coloplast Titan), no significant differences were seen in functional outcomes or patient satisfaction. Simple insertion of an IPP has been shown to resolve curvature in 33–90% of patients, but surgeons may often need to also utilize ancillary straightening procedures for residual curvatures. Manual modeling can correct residual curvature with an 86–100% success rate, but with a 4% risk of urethral injury. When the post-modeling residual curvature exceeds 30 degrees, a plaque-releasing incision or plication is recommended to further reduce curvature. Grafting is recommended if the resulting incisional defect is larger than two centimeters. Alternative straightening techniques such as plication prior to IPP insertion, endoscopic plaque resection, the “scratch technique” and bone saw plaque incision have also been described.

Surgical Management of Peyronie’s Disease With Co-Existent Erectile Dysfunction

“…16,21,23À28 PP þ Plication If there is persistence of a 30À40 degree curvature after MM in a patient with adequate penile length and no hour-glass deformity, then plication can be attempted to improve the residual curvature. 29 Nesbit's plication involved excising a strip of the plaque containing tunica albuginea and subsequent reapproximation of the tunical edges, whereas the less invasive Essed-Schroeder technique involved plication without any tunical incision. 30 The 16/24-dot technique is a modification of Essed-Schroeder plication involving application of 2 (16 dots) or 3 (24 dots) pairs of plications depending on the degree of curvature.…”

“…33 To prevent cylinder herniation or curvature recurrence due to scar contracture, grafting is usually recommended when the tunical incisional defect is larger than 2 cm. 29 There are 3 approaches: i) combined peno-scrotal incision for PP placement and degloving circumcoronal penile incision for plication or grafting; ii) circumcoronal penile degloving incision alone; or iii) penoscrotal incision with the penile inversion technique.…”

Nondegloving technique for Peyronie′s disease with penile prosthesis implantation and double dorsal-ventral patch graft

“…Loss of penile length has been reported in 54% of patients postoperatively and is one of the primary concerns of patients. 16 Maximal sizing and postoperative rehabilitation with inflatable PP implantation have been recommended to prevent the loss of penile length in patients with severe ED unrelated to PD. 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.…”

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.…”