Combined Penile Plication Surgery and Insertion of Penile Prosthesis for Severe Penile Curvature and Erectile Dysfunction

Rahman, Nadeem U.; Carrión, Rafael; Bochinski, Derek; Lue, Tom F.

doi:10.1097/01.ju.0000124042.74905.70

Cited by 46 publications

(35 citation statements)

References 15 publications

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“…An alternative to this would be to perform a tunic plication such as the 16-dot suture technique contralateral to the curvature before placement of the prosthesis so as to correct curvature. 79 When there is residual curve of greater than 30u or residual indentation causing the inflated cylinder to buckle, tunical incision is recommended after elevating Buck's fascia in that area. The transverse penoscrotal skin incision will allow access to virtually the entire shaft, except when the curvature is distal on the shaft, so degloving the penis is not always necessary.…”

Section: Indicationsmentioning

confidence: 99%

Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

105

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Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 706 without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems. Keywords: penile prosthesis; Peyronie's disease, penile reconstruction; plaque excision and grafting; plaque incision; tunica albuginea plication INTRODUCTION Peyronie's disease (PD) is most simply referred to as a fibrotic woundhealing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing, shortening and painful erections. 1 The perceived loss of length and girth is often more disturbing than the curvature itself, all of which can lead to moderate to severe depressive symptoms, emotional, and relationship problems. 2,3 Despite a myriad of treatment options, PD remains a considerable therapeutic dilemma due to several factors including an incomplete understanding of its etiopathophysiology and the relative paucity of randomized, placebo-controlled trials. A general explanation of this disorder, which has gained acceptance, is that PD is a disorder in which genetically susceptible individuals experience a localized response to endogenous factors such as tumor growth factor-b, which are released in response to microtrauma. This can lead to biological transformation of cells within the tunica albuginea, cell cycle dysregulation, genotypic changes and increased expression of cytokines and free radicals. This inflammatory response leads to unregulated extracellular matrix deposition including fibronectin and collagen, and ultimately plaque scar formation, which does not appear to undergo proper scar remodeling, leaving an inelastic segment in the involved tunica albuginea. [4][5][6][7][8][9] Although a variety of non-surgical treatments have been suggested, none offer a r...

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Section: Indicationsmentioning

confidence: 99%

Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

105

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“…If penile curvature is less than 30°in patients with PD with concomitant erectile dysfunction, placement of inflatable prostheses may be sufficient to achieve penile straightening. Surgical algorithms [137,138] recommend manual modeling as described by Wilson and Delk [132] if the residual curve is greater than 30°and observation if the curve is less than 30°because the prosthesis usually corrects the deformity within 6-9 months [1••]. If manual modeling fails to correct the curve to less than 30°, then plaque-releasing incisions can be performed on the concave side and grafting if the tunical defect is larger than 2 cm [1••].…”

Section: Penile Prosthesis Implantationmentioning

confidence: 99%

Treatment of Peyronie’s Disease: 2012 Update

Şerefoğlu

2011

Curr Urol Rep

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Peyronie's disease (PD) is the occurrence of a fibrous inelastic scar of the tunica albuginea of the penis. It is a relatively common disorder among men, with a reported prevalence of 3% to 8%. It is often associated with penile pain, anatomical deformities in the erect state, and difficulty with intromission. Because the exact pathophysiology of PD remains unknown and standards for evaluating or reporting treatment outcomes are unclear, research on effective therapies has been limited. The benefits of nonsurgical treatment options are conflicting and further controlled studies are required before any therapy can be fully recommended. The success of surgery has been well documented; however, surgery is invasive and costly and carries potential side effects. Patients who report stable disease that has been present for longer than 12 months and who experience penile deformity preventing satisfactory sexual intercourse are best suited for surgery. Additionally, failed conservative management and a patient's preference for definitive correction are important additional indications for surgical treatment.

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“…Prosthetics are typically used in the situation where there is significant loss of erectile rigidity such that straightening alone will not allow successful coitus. Concurrent plication and prosthesis placement has been shown to lead to durable cosmetic and functional results [Rahman et al 2004], and is frequently employed in our patients with severe curvature and coexisting refractory ED.…”

Section: Surgical Plication Options Formentioning

confidence: 99%

Update on plication procedures for Peyronie’s disease and other penile deformities

Mobley

Fuchs

Myers

et al. 2012

Therapeutic Advances in Urology

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Plication techniques are not a panacea for deformities associated with Peyronie's disease or congenital curvature. However, they do provide certain advantages, both theoretic and real, over competing procedures such as grafting. Depending on the technique, plication procedures have minimal risk of de novo erectile dysfunction, minimal risk of injury to the dorsal neurovascular bundle, and may be used for a variety of angulation deformities, including multiplanar curvature and severe degrees of curvature. A variety of incisions may be used, including the classic circumcision with degloving but also ventral raphe, dorsal penile inversion, and penoscrotal. These may be helpful in preventing postoperative morbidity and in sparing the prepuce if desired. Plication may also be combined with procedures such as penile prosthesis for correction of residual curvature. Lastly, despite its complications, plication techniques are very well tolerated, are relatively simple to perform and result in the very high satisfaction rates.

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Combined Penile Plication Surgery and Insertion of Penile Prosthesis for Severe Penile Curvature and Erectile Dysfunction

Abstract: In cases of severe penile deformity and curvature with erectile dysfunction the combination of penile plication and inflatable penile prosthesis placement is a method of repair that is well tolerated.

Cited by 46 publications

References 15 publications

Surgery for Peyronie's disease

Surgery for Peyronie's disease

Treatment of Peyronie’s Disease: 2012 Update

Update on plication procedures for Peyronie’s disease and other penile deformities

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