Plaque incision and grafting represents the best surgical approach to the Peyronie’s disease patient: Pro

Various surgical modalities have been utilized for the treatment of penile tortuosity caused by Peyronie’s disease. However, the ideal surgical procedure has not yet been developed. Because plaque incision and grafting does not cause penile shortening, it is the best approach, particularly in cases of severe and complex penile curvature. Additionally, if the graft is nonsynthetic, neither inflammatory nor anomalous scarring will develop over time. This review suggests crural corpora cavernosa as the graft of choice, because it more closely resembles the incised area both anatomically and functionally.     

Surgical decisions in Peyronie’s disease

In this review, we examine recent advances assisting surgical decision in Peyronie’s disease. Surgical treatment is indicated in penile deformities that have persisted for at least 6 months and functionally impair or preclude intercourse. Procedures shortening the longer side of the penis are invariably associated with length reduction, which may displease patients, despite penile straightening. Procedures lengthening the shorter side by means of grafting provide the best possible gain from a reconstruction procedure, although they may not restore the penis to its original length. Penile rectification and rigidity are required to achieve complete functional restoration of the penis. Most patients experience associated erectile dysfunction, and penile straightening alone may not be enough to restore complete function. Therefore, in some cases, phosphodiesterase inhibitors, self-injection, or a penile prosthesis may need to be added. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed.     

Modified salvage for inflatable penile prosthesis revision

Although penile prosthetic implants are reliable and postoperative morbidity is low, infection related to prosthetic surgery is still a concern. Treatment of infected penile prostheses entails considerable medical and surgical costs. Various salvage approaches have been advanced in recent years, with varying rates of success. Ultimately, modified salvage with antiseptic solutions and vigorous irrigation seems to decrease the infection rate and bacterial presence during penile prosthesis revision for noninfectious reasons.     

Translating Penile Erectile Hydraulics to Clinical Application in Inflatable Penile Prosthesis Implant

Purpose of Review

To review the concept of erectile hydraulics and the scientific advances in modern inflatable penile prosthesis implant.

Recent Findings

Penile erection requires the presence of nitric oxide, relaxation of the penile vasculature, and engorgement of corpora cavernosa sinusoids. It is generally accepted that the development of erectile dysfunction is frequently attributed to both psychogenic factors as well as physiological alterations in neural, vascular, hormonal and endothelial function. Despite the advent of oral and intracavernosal erectile drugs, penile prosthesis implant remains a relevant and desired option as many men became refractory to medical therapy and/or seek a more effective and permanent solution.

Summary

The inflatable penile prosthesis is considered a superior option to malleable prosthesis as it closely replicates a normal penile erection. While the ideal penile prosthesis is probably yet to be developed, scientific advances in prosthesis design, device technology, and surgical techniques have made the penile prosthesis more natural, durable and reliable device.

     

Tunical Incision Techniques for Peyronie’s Disease

Purpose of Review

Tunical plaque incisions are common techniques utilized during grafting procedures for Peyronie’s disease. The aim of this review was to examine the different tunical incisional and excisional techniques, as well as outcomes and complications of recent graft procedures utilizing these strategies.

Recent Findings

Studies on tunical incision, partial excision, and grafting techniques vary with regards to their surgical outcomes, post-operative erectile dysfunction rates, and other complications. Overall, significant penile straightening has been reported in recent studies of incision and grafting for Peyronie’s disease.

Summary

Prospective trials comparing the different tunical incisional techniques are needed to better plan surgical interventions for Peyronie’s disease.

     

Penile paraffinoma

A 40-year-old Caucasian man, originating from Ukraine, but living for the last year and a half in Portugal, presented to our department with a one year history of an irregular penile mass and phimosis. He reluctantly admitted that 8 years previously he had multiple mineral oil injections in the penis, for the purpose of penile enlargement. A diagnosis of penile paraffinoma was made and surgical excision was performed at the urology department. Paraffinoma results from mineral-oil injections: such practice is very rare in the western world nowadays, however, it still is performed in many Eastern European Countries.     

Distal Extrusion and Impending Cylinder Erosion of the Penile Prosthesis: a Clinical Challenge for the Urologist

Distal extrusion with impending cylinder erosion through the distal corpus cavernosum is a significant complication of penile prosthesis surgery. Surgical repair is indicated to prevent cylinder perforation or erosion through the skin, which leads to infection and requires removal of all prosthesis components. The underlying cause is typically unrecognized tunical perforation during surgery, aggressive distal dilation, oversized cylinders, or repeated trauma. Extrusion is more common in patients with microangiopathy, prior radiation, corporal fibrosis, or decreased distal sensation. The two most prevalent methods for repair are distal corporoplasty or windsock graft reconstruction. Distal corporoplasty has been demonstrated to have superior outcomes to windsock grafts and is the method of repair that these authors favor. The goal of this review is to provide a background on distal penile prosthesis extrusion, along with potential treatment approaches, so that the surgeon may be familiar with this seemingly difficult, albeit rare, complication of penile prosthesis surgery.     

Immediate post-operative complications (I): Post-operative bleeding; vascular origin: Thrombosis pancreatitis

Simultaneous pancreas-kidney transplantation is the treatment of choice for insulin-dependent diabetes that associates end-stage diabetic nephropathy, since it achieves not only a clear improvement in the quality of life, but also provides a long-term survival advantage over isolated kidney transplant. However, pancreas transplantation still has the highest rate of surgical complications among organ transplants. More than 70% of early graft losses are attributed to technical failures, that is, to a non-immunological cause. The so-called technical failures include graft thrombosis, bleeding, infection, pancreatitis, anastomotic leak and pancreatic fistula. Pancreatic graft thrombosis leads these technical complications as the most frequent cause of early graft loss. Currently most recipients receive postoperative anticoagulation with the aim of reducing the rate of thrombosis. Hemoperitoneum in the early postoperative period is a frequent cause of relaparotomy, but it is not usually associated with graft loss. The incidence of hemoperitoneum is clearly related to the use of anticoagulation in the postoperative period. Post-transplant pancreatitis is another cause of early postoperative complications, less frequent than the previous. In this review, we analyze the most common surgical complications that determine pancreatic graft losses.     

Surgical management of Peyronie’s disease: Which operation?

Multiple treatment options are currently available for Peyronie’s disease (PD) and include minimally invasive interventions. Surgical treatments are considered the best option when the plaque proves refractory to these treatments, when penile curvature is severe, or when erectile dysfunction is vascular or mechanical. Most surgeons experienced in surgical management of PD use a wide range of procedures including plication procedures, plaque incision/excision with grafting, or implantation of a penile prosthesis. This article assesses the indications for surgery, the various surgical procedures available, when and to whom surgery should be offered, and the expected results and complications.