Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference

Abstract

Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie’s disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

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

“…When IPP insertion alone does not sufficiently correct penile curvature, manual modeling is the next step to reduce residual curvature ( 1 , 7 , 17 , 19 , 20 , 62 , 63 ). Most studies have shown that between 10% and 61% of patients with PD may need additional straightening procedures after simple IPP implantation ( 6 , 17 - 19 , 26 , 53 , 54 ).…”

“…While modeling is highly successful in adjusting residual curvature after IPP insertion, many authors have reported significant residual curvature in 20–30% of patients that required additional surgery ( 68 ). When post-modeling residual curvature exceeds 30°, most algorithms recommend a plaque-releasing incision or plication to further reduce the curvature ( 1 , 7 , 19 , 20 , 62 , 69 , 70 ). A releasing incision is a lengthening procedure, such that a dissection made in the fibrotic plaque of the tunica albuginea overlying the area of maximum curvature lengthens the concave side of the penis.…”

“…After the point of maximum curvature is detected via artificial erection, a nasal speculum is passed through the infrapubic corporotomy incision, and a scalpel or scissors are inserted internally to “scratch” or scrape, the plaque. The IPP is then implanted in normal fashion, and manual modeling may be performed if necessary ( 62 ). To date, no clinical trials have been published using the “scratch” technique.…”