High Patient Satisfaction of Inflatable Penile Prosthesis Insertion with Synchronous Penile Plication for Erectile Dysfunction and Peyronie's Disease

IntroductionTwenty to thirty percent of patients with Peyronie's disease (PD) have erectile dysfunction (ED) refractory to medical therapy and may benefit from a combined procedure addressing both conditions.AimThe aim of this study was to show the efficacy of inflatable penile prosthesis (IPP) insertion and synchronous penile plication for correcting penile curvature and ED in patients with PD.MethodsA retrospective review was performed of all patients who underwent IPP insertion with synchronous penile plication at our tertiary care center between 2010 and 2013. All patients received an intraoperative saline intracorporal injection to induce an artificial erection. After the tunica albuginea was exposed via a standard transverse scrotal incision over the proximal penile shaft, the incision was retracted distally and/or laterally as needed for plication suture placement. Plication sutures were placed in parallel opposite the angle of greatest curvature. The incision was returned proximally to the standard penoscrotal junction for IPP insertion. Demographic and surgical data were collected from the patients' medical records. Patient satisfaction was assessed postoperatively using a nonvalidated questionnaire.Main Outcome MeasuresThe focus of this study was surgical outcomes, both technical and patient-reported satisfaction.ResultsEighteen patients with a mean age of 63 years underwent IPP insertion with synchronous penile plication. Patients presented with dorsal (n = 11), lateral (n = 2), and biplanar curvature (n = 5). Mean preoperative curvature was 39 degrees (range 30–60) and was corrected on average to <5 degrees (range <5–12) using a median of four plication sutures (range 3–6). Among 15 patients completing a postoperative satisfaction survey at a mean of 11 months, all reported improvement in their overall condition and penile curvature; one with biplanar deformity reported minor residual curvature. None reported continued pain or required suture release.ConclusionsIPP insertion with synchronous penile plication for the correction of ED and PD is effective and results in high patient satisfaction. Chung PH, Scott JF, and Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie's disease. J Sex Med 2014;11:1593–1598.     

Dorsal Vein Injuries Observed During Penile Exploration for Suspected Penile Fracture

IntroductionPenile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear.AimWe present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear.MethodsEighteen men (mean age 38 years, range 20–55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries.Main Outcome MeasuresMedical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up.ResultsIn nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4–91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear.ConclusionsDorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery. Bar-Yosef Y, Greenstein A, Beri A, Lidawi G, Matzkin H, and Chen J. Dorsal vein injuries observed during penile exploration for suspected penile fracture.     

New plication technique for the treatment of congenital penile curvature

Introduction:  Conditions that cause curvature of the erect penis also lead to difficulties with intercourse. The present study presents an effective surgical treatment for congenital penile curvature.
Methods:  Between March 1996 and August 2004, 49 patients were diagnosed with congenital penile curvature at the Toho University Omori Hospital Reproduction Center, Tokyo. Of these, 27 eligible patients underwent surgical treatment. The operative technique used involved the tunica albuginea being exposed and a number of vertical incisions were made through its superficial layers. The superficial layer of the tunica albuginea was then resected using scissors. Inverted plication sutures were then placed in the raw surface of the corpus cavernosum using 2-0 nylon. In addition, 2-0 polyglactic acid (Vicryl) sutures were placed on either side of each nylon suture knot.
Results:  Of a total of 49 patients, 27 eligible patients underwent surgical treatment with no serious postoperative complications. All 27 patients were able to sustain intercourse. There were no new cases of erectile dysfunction, penile pain or penile shortening. There were no recurrences of penile curvature.
Conclusions:  This new partial thickness shaving, inverted sutures reinforced with dissolving sutures plication method is an extremely effective surgical treatment for congenital penile curvature, with a superior safety profile. (Reprod Med Biol 2005; 4 : 255–258)     

Surgical Correction of Persistent Peyronie's Disease Following Collagenase Clostridium Histolyticum Treatment

IntroductionCollagenase clostridium histolyticum (CCH) is an Food and Drug Administration‐approved intralesional injection for treatment of Peyronie's disease (PD) that has been shown to reduce penile curvature deformity and PD symptom bother in phase 2b and phase 3 placebo‐controlled clinical trials. For some patients, nonsurgical treatment with CCH may not sufficiently improve penile curvature, and surgical correction may be pursued following CCH therapy.AimThis study aims to examine intraoperative and postsurgical outcomes of surgical correction of persistent penile curvature in patients with PD who had previously received CCH.MethodsRetrospective chart review was used to identify patients with PD who had received CCH intralesional injection within either the phase 2b or phase 3 CCH clinical trials and then underwent surgical correction due to remaining penile curvature. Surgical techniques used were partial plaque excision and grafting (PEG) and/or tunica albuginea plication (TAP).Main Outcome MeasuresPrimary assessments included pre‐ and postsurgery penile curvature, erectile rigidity, stretched penile length, intraoperative time, and occurrence of adverse events.ResultsSeven men were identified who underwent surgical straightening with TAP or PEG following CCH treatment. Mean number of days from the final CCH injection to surgery was 182 (standard deviation 118; median 127 days). Average penile curvature prior to surgical straightening was 58°. No anatomical difficulties or complications secondary to the effects of prior CCH treatment occurred during surgery. Intraoperative time was representative of standard TAP and PEG surgeries (range 88–146 minutes). All men reported penile curvature <20° postsurgery. One patient experienced a postsurgery subgraft hematoma that required aspiration. There were no postsurgery reports of decreased penile sexual sensation and no occurrence of vascular compromise or decreased penile rigidity.ConclusionThis initial case series supports the hypothesis that prior CCH treatment is not a contraindication to PEG or TAP surgery in the treatment of penile curvature in patients with PD. Levine LA and Larsen SM. Surgical correction of persistent Peyronie's disease following collagenase clostridium histolyticum treatment. J Sex Med 2015;12:259–264.     

An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures

BackgroundPeyronie’s disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage.AimThe goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa.MethodsBetween February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie’s disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting.OutcomesIn accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity.ResultsThe sample of 416 patients included 287 cases of Peyronie’s disease having a mean axial deviation of 51° (0–90°) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2–6) was measured intraoperatively.Clinical ImplicationsDiagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient’s subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics.Strengths and LimitationsThe TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle.ConclusionsThe TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity.Paulo H. Egydio, An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures. J Sex Med 2020;17:2093–2103.     

Continuing Medical Education: A Case of Mechanical Failure with Proximal Perforation at the Time of Revision Surgery (CME)

BackgroundImplantation of inflatable penile prosthesis (IPP) is a well-established treatment for medically refractory erectile dysfunction with proven long-term reliability. However, if an IPP fails, the subsequent surgery to fix the IPP can be more difficult with higher risks of complications than the primary implantation.AimsTo review and evaluate a case of a difficult IPP replacement surgery for ways to improve surgical techniques and outcomes.Materials & MethodsPerform a case report of a difficult IPP replacement surgery in which the patient had proximal perforation of the tunica albuginea with a review of the pertinent literature.ResultsThe rear tip sling is a successful way to repair proximal perforation of the tunica albuginea. Recent publications show new surgical techniques to lower infection rates in IPP revision surgery.DiscussionThe rear tip sling appears to have better outcomes than a synthetic windsock for repairs of proximal perforation of the tunica albuginea. Recent publications have shown that the revision washout decreases penile prosthesis infection rates in revision surgeries.ConclusionWhile revision surgery for IPPs have higher risks than primary implantation, newer surgical techniques are helping to reduce these risks. Zanoni M, and Henry GD. A case of mechanical failure with proximal perforation at the time of revision surgery. J Sex Med 2009;6:2629–2632.     

One-stage correction of congenital complex penile curvature by tunica albuginea plications.

BACKGROUND AND PURPOSE: Congenital complex penile curvature has two deformity components: torsion and curvature of the penile shaft. Limited cases have been reported and were managed with an invasive Nesbit procedure. We introduce a novel simple surgical technique to correct the deformity in one stage. PATIENTS AND METHODS: Plications of the tunica albuginea were applied to treat five patients (median age, 28 yr) with congenital complex penile curvature. Mean follow-up duration was 14 months (range, 9-20 mo). In the first case, penile curvature was corrected first followed by the torsion. In the other four cases, the sequence was reversed. A parabolic curve was made from the subcoronal area crossing the dorsal midline and extending toward the penile base obliquely to the direction of counter-torsion. Along the curve, two points (one at the maximum convexity and the other depending on the type of curvature) were chosen for plications to correct torsion. The remaining curvature was corrected subsequently. RESULTS: It took five plications to accomplish a satisfactory result in the first case. In the other four cases, only three plications were needed to correct the deformity. In all five patients, penile deformities were corrected successfully with either residual torsion or curvature being no more than 5 degrees. All patients were satisfied with excellent cosmetic and functional results with no recurrent curvature or torsion. All patients had started successful sexual intercourse shortly more than 2 months after the operation without erectile problems. One patient reported a mild sensory impairment of the penile skin that resolved 2 months later. CONCLUSIONS: By correcting penile torsion and curvature in sequence with plications of the tunica albuginea, congenital complex penile curvature can be corrected in a one-stage operation with good cosmetic and functional results.     

Penile Duplex Ultrasonography in Men with Peyronie's Disease: Is it Veno‐Occlusive Dysfunction or Poor Cavernosal Arterial Inflow that Contributes to Erectile Dysfunction?

IntroductionAt least 20% of men with Peyronie's disease (PD) suffer from erectile dysfunction (ED). The fundamental mechanism is thought to arise from the progression of penile fibrosis, which was initially limited to the PD plaque within the tunica albuginea. However, recent studies have highlighted the possibility of fibrosis of the cavernosal vessel media wall leading to impairment of arterial inflow.AimTo evaluate the penile duplex ultrasonographic findings in PD of impotent men and to determine whether early features of PD might predict clinical progression.Main Outcome MeasuresPatient demographic, comorbidities, International Index of Erectile Function‐5 scores, surgical intervention, and physical findings were documented. Penile curvature, plaque size, and peak systolic velocity (PSV) and end‐diastolic velocity (EDV) on color duplex ultrasonography (CDU) were recorded.MethodsWe performed a retrospective review of all men presenting with penile curvature and length loss who underwent penile CDU between January 2001 and January 2010.ResultsA total of 1,120 men underwent penile CDU during the 10‐year period. Complete information was obtained in 810 men; 250 men complained of decreased penile rigidity, while 150 men were unable to sustain erection. Comorbidities were similar between men with PD with and without ED. Tunical thickening (65%) was the most common CDU feature, and mean cumulative calcifications was 24.2 mm² (1–360 mm², standard deviation 76). The PSV and EDV on the right cavernosal artery were 14.2 cm/second and 3.5 cm/second, while the left cavernosal artery measurements were 15.1 cm/second and 3.2 cm/second. Multivariate logistic regression model showed strong correlation between plaque size and development of ED. Both veno‐occlusive dysfunction and impaired cavernosal arterial inflow were associated with ED.ConclusionsVeno‐occlusive dysfunction and impaired cavernosal arterial inflow contributed to the development of ED, and larger plaque size is a strong predictor of surgical intervention. Chung E, De Young L, and Brock GB. Penile duplex ultrasonography in men with Peyronie's disease: Is it veno‐occlusive dysfunction or poor cavernosal arterial inflow that contributes to erectile dysfunction? J Sex Med **;**:**–**.     

Human acellular matrix graft of tunica albuginea for penile reconstruction

IntroductionPenile curvature is one of the most common male conditions, affecting nearly 10% of men, and can impair sexual intercourse. Tunica albuginea (hTA) plays a key role in penile curvature, and reconstructive procedures may be necessary for its substitution. Although several grafts have been proposed for hTA repair, the ideal graft is not yet available.AimThe aim of this article is to evaluate a new human tunica albuginea acellular matrix (hTAAM) as potential graft for penile reconstructive procedures.MethodsTwelve penises were obtained during sex reassignment surgeries from male‐to‐female transsexual patients. After dissection, hTAs were assigned into two groups according to the decellularization methods: polyethylene glycol (PEG) 1000 method following ultraviolet‐C radiation, and Triton X‐100 modified method.Main Outcome MeasuresStructural analyses were assessed by hematoxilin and eosin, Masson's trichrome, Weigert's, and picrosirius‐polarization staining methods. Total protein, total glycosaminoglycan (GAG), and nucleic acid (DNA and RNA) concentrations were assessed by specific biochemical analyses. Uniaxial strength tests were performed to evaluate biomechanical properties.ResultsAll hTAAMs presented no nuclear or cellular remnants. Total protein concentration was significantly higher in PEG 1000 hTAAM. Despite GAG concentration decreased significantly in hTAAM, Triton X‐100 hTAAM retained the highest GAG concentration (1.0 ± 0.42 µg HexUr/mg dry tissue, P > 0.05). All decellularization methods were efficacious to remove nucleic acids. The maximal break point presented no difference between hTA and hTAAM groups (P > 0.05).ConclusionsPEG 1000 and Triton X‐100 decellularization methods provide equally successful hTAAMs, preserving original structural and biochemical properties. da Silva FG, Filho AM, Damião R, and da Silva EA. Human acellular matrix graft of tunica albuginea for penile reconstruction. J Sex Med 2011;8:3196–3203.     

Cryopreserved Penile Tunica Albuginea for Allotransplantation: A Morphological and Ultrastructural Investigation

IntroductionPeyronie's disease, a connective tissue disorder of penile tunica albuginea (TA) associated with penile deformity, curvature, pain, and erectile dysfunction, is best managed surgically, but suitable graft biomaterials are not available.AimTo establish whether cryopreservation affects human TA in view of its use in allotransplants.MethodsThe effects on TA samples of the two most widely used tissue cryopreservation methods were investigated using an ad hoc panel of histochemical, immunohistochemical, and ultrastructural tests. Apoptotic cells were evaluated using the terminal deoxynucleotidyl transferase method of end labeling (TUNEL) assay.Main Outcome MeasuresAssessment of tissue integrity and arrangement of collagen and elastic fibers in thawed TA.ResultsBoth cryofixation methods provided TA tissue suitable for use as graft material. Significant ultrastructural changes, namely, a greater diameter of collagen fibrils, were detected in sections preserved in liquid nitrogen; nonetheless, such increase never exceeded the normal range. The comprehensive panel of assays used proved suitable to characterize the thawed tissue.ConclusionHuman TA is suitable for cryopreservation; freezing at ?80°C provides better results than preservation in liquid nitrogen. Loreto C, Orlandi A, Ferlosio A, Djinovic R, Basic D, Bettocchi C, Rutigliano M, Barbagli G, Vespasiani G, Caltabiano R, Musumeci G, and Sansalone S. Cryopreserved penile tunica albuginea for allotransplantation: A morphological and ultrastructural investigation. J Sex Med 2012;9:2378–2388.     

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

BackgroundCongenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined.AimTo provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC.MethodsA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus.OutcomesObjective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized.ResultsFifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of “treatment success” varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20?. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes.Clinical ImplicationsWhile both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting.Strength & LimitationsThis report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review.ConclusionBoth plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature.C. J. Britton, F. A. Jefferson, B. L. Findlay, et al. Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review. J Sex Med 2022;19:364–376.     

Predicting erectile dysfunction following surgical correction of Peyronie's disease without inflatable penile prosthesis placement: vascular assessment and preoperative risk factors

IntroductionSurgical therapy remains the gold standard treatment for Peyronie's Disease (PD). Surgical options include plication, grafting, and placement of inflatable penile prosthesis (IPP). Postoperative erectile dysfunction (ED) is a potential complication for PD surgery without IPP. We present our large series follow‐up to evaluate preoperative risk factors for postoperative ED.AimsThe aim of this study is to evaluate preoperative risk factors for the development of ED following surgical correction of PD taking into account the degree of curvature, graft size, surgical approach, hypertension, hyperlipidemia, diabetes, smoking history, preoperative use of phosphodiesterase 5 inhibitors (PDE5), and preoperative duplex ultrasound findings including peak systolic and end diastolic velocities and resistive index.MethodsWe identified 218 men undergoing either tunica albuginea plication (TAP) or partial plaque excision with pericardial grafting for PD following a previously published algorithm between November 1992 and April 2007. Preoperative and postoperative erectile function, curvature characteristics, presence of vascular risk factors, and duplex ultrasound findings were available on 109 patients.Main Outcome MeasuresOur primary outcome measure is the development of ED after surgery for PD.ResultsTen percent of TAP and 21% of plaque excision with grafting patients developed postoperative ED. Neither curve direction (P = 0.76), graft area (P = 0.78), surgical approach (P = 0.12), chronic hypertension (P = 0.51), hyperlipidemia (P = 0.87), diabetes (P = 0.69), nor smoking history (P = 0.99) were significant predictors of postoperative ED. No combination of risk factors was found to be predictive of postoperative ED. Preoperative use of PDE5 was not a significant predictor of postoperative ED (P = 0.33). Neither peak systolic, end diastolic, nor resistive index were significant predictors of ED (P = 0.28, 0.28, and 0.25, respectively).ConclusionThis long‐term follow‐up of a large published series suggests that neither preoperative risk factors nor preoperative duplex ultrasound findings are predictive of postoperative ED, thus reinforcing the use of previously published preoperative treatment algorithms. Taylor FL, Abern MR, and Levine LA. Predicting erectile dysfunction following surgical correction of peyronie's disease without inflatable penile prosthesis placement: Vascular assessment and preoperative risk factors. J Sex Med 2011;9:296–301.     

Standard Operating Procedures for Peyronie's Disease

IntroductionPeyronie's disease (PD) refers to a penile deformity that is associated with sexual dysfunction.AimTo provide recommendations and Standard Operating Procedures (SOPs) based on best evidence for diagnosis and treatment of PD.MethodsMedical literature was reviewed and combined with expert opinion of the authors.Main Outcome MeasuresRecommendations and SOPs based on grading of evidence–based medical literature.ResultsPD is a fibrotic wound-healing disorder involving the tunica albuginea of the corpora cavernosa. The resulting scar is responsible for a variety of deformities, including curvature, shortening, narrowing with hinge effect, and is frequently associated in the early phase with pain. Patients frequently experience diminished quality erections. All of these conditions can compromise sexual function for the affected male. The etiopathophysiology of PD has yet to be clarified and as a result, effective, reliable, mechanistic directed non-surgical therapy is lacking.ConclusionsThe management of PD consists of proper diagnosis and treatment, ranging from non-surgical to surgical interventions. The main state of treatment for PD rests at this time on surgical correction that should be based on clear indications, involve surgical consent, and follow a surgical algorithm that includes tunica plication, plaque incision/partial excision and grafting, and penile prosthesis implantation. Levine LA and Burnett AL. Standard operating procedures for Peyronie's disease. J Sex Med 2013;10:230-244.     

A Retrospective Comparative Study of Traction Therapy vs. No Traction Following Tunica Albuginea Plication or Partial Excision and Grafting for Peyronie's Disease: Measured Lengths and Patient Perceptions

IntroductionLoss of penile length is a recognized and common consequence of Peyronie's disease (PD). Traction therapy (TT+) has been reported to decrease post‐op length loss as well as increase stretched penile length (SPL) prior to surgery.AimThe aim of this study was to study patient outcomes with penile length change and patient satisfaction after surgery following tunica albuginea plication (TAP) and partial plaque excision and grafting (PEG) with or without postoperative TT.MethodsRetrospective analysis was performed from our cohort of Peyronie's reconstructive surgery between 2007 and 2010. SPL was measured dorsally from pubis to corona and recorded at the initial office visit and then compared to most recent postoperative visit. Patients were then stratified by procedure and whether TT was used (TT+ and TT?; TAP N = 52 [27 TT+ and 25 TT?] and PEG N = 59 [36 TT+ and 23 TT?). Traction therapy was initiated for >2 hours a day for 3 months typically starting 3–4 weeks postoperatively. A non‐validated mailed questionnaire assessed patient perceptions.ResultsMean length change seen in TAP (TT+) was 0.85 cm (0.25–1.75) vs. ?0.53 cm (?1.75 to 0.5) in TAP (TT?) (P < 0.001). The mean length change seen in PEG (TT+) was 1.48 cm (0–6) vs. PEG (TT?) 0.24 cm (?1 to 2.5 cm) (P < 0.001). Sixty‐one percent of surveys were returned; 85% lost length prior to the initial office evaluation, with an average of ?2.5 cm lost. Importantly, in those who used traction, there was no perceived length loss, 58% reported a mean erect length gain of 1.1 cm. However, only 54% of all patients were satisfied with their current erect length.ConclusionsLoss of length in men with PD remains a serious concern. It appears that postoperative TT can result in length preservation, and in many, a measured and perceived length gain following correction of the curvature. Rybak J, Papagiannopoulos D, and Levine L. A retrospective comparative study of traction therapy vs. no traction following tunica albuginea plication or partial excision and grafting for Peyronie's disease: Measured lengths and patient perceptions. J Sex Med 2012;9:2396–2403.     

DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases

BackgroundA total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014.AimTo investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias.MethodsIn all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year.OutcomesAt the final postoperative follow-up, the patients' satisfaction with the operation was found to be 95.8%.ResultsShortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction.Strengths & LimitationsThe limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events.ConclusionAccording to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures.Akdemir F, Kayıgil Ö, Okulu E. DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases. J Sex Med 2021;18:1715–1720.     

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

IntroductionPeyronie'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.AimTo 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.MethodsWe 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).ResultsThe average operative time was 2 hours and 50 minutes. No major intraoperative nor postoperative complications occurred. No significant bleedings were recorded. Patients were discharged after 48–72 hours.The average increase in length obtained was 3.2 cm. All patients resumed sexual intercourses with satisfaction; no significant loss of sensitivity or any sign of vascular distress of the glans was recorded. The follow‐up is 13 months. The average IIEF score is 60.ConclusionsThe lengthening of the penis by a double dorsal‐ventral patch graft is an innovative procedure that is based on current techniques of plaque incision and grafting, and that can easily resolve severe shortening of the penis due to Peyronie's disease. In the cases presented, this procedure resulted easily, effectively, and safely. Nevertheless, the technique proposed in this article shall be validated through prospective studies with larger samples. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, Falcone M, and Fontana D. A new, innovative, lengthening surgical procedure for Peyronie's disease by penile prosthesis implantation with double dorsal‐ventral patch graft: The “sliding technique.” J Sex Med 2012;9:2389–2395.     

Continuing Medical Education: Incision and Grafting for Severe Peyronie's Disease (CME)

BackgroundPeyronie's Disease is a wound healing disorder involving growth of fibrous plaques in the tunica albuginea, and often results in abnormal penile curvature and subsequent development of erectile dysfunction. A 59-year-old man with a history of untreated penile trauma who presented with a 6-year history of worsening penile curvature that interfered with sexual functioning and resulted in associated erectile dysfunction.MethodsThe patient's Peyronie's Disease was evaluated in clinic with a focused physical exam and a penile vasculature study using a color duplex Doppler ultrasound. Since the patient did not have proper insurance coverage for an inflatable penile prosthesis, but did have normal arterial flow with only boderline veno-occlusive disease, he instead underwent an incision and grafting procedure. After degloving the penis, a lateral approach parallel to the corpus spongiosum was used to enter Buck's fascia and isolate the neurovascular bundles. The fibrous plaque was incised with a residual tunical defect of 4 × 5 cm, and covered with a pericardial graft.ResultsPreoperatively, artificially induced erection during the patient's Doppler study demonstrated dorsal curvature greater than 80 degrees. Intraoperatively, after completing the incision and grafting procedure, artificial erection demonstrated minimal (less than 15 degrees) residual curvature. At his 1-week postoperative visit, he reported spontaneous erections and minimal pain. One month postoperatively, his incisions were well healed and an artificially induced erection continued to demonstrate minimal curvature.DiscussionManagement of severe Peyronie's Disease with significant penile curvature is a challenging clinical problem. In extreme cases, placement of an inflatable penile prosthesis with ancillary techniques usually gives the best clinical outcome. Although more difficult to execute in severe cases, incision and grafting represents an acceptable alternative in the appropriately selected patient. Richardson B, Pinsky MR, and Hellstrom WJG. Incision and grafting for severe peyronie's disease. J Sex Med 2009;6:2084–2087.     

Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature

Background

There are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening (<20 degrees).

Surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease

IntroductionPeyronie's disease, a localized fibrosis of the tunica albuginea surrounding the penile corpora, results in penile curvature and sexual dysfunction. Surgical management involving grafting to straighten the penis is the treatment of choice in conditions unresponsive to conservative therapy where penile length preservation is important.AimTo determine surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease.Main Outcome MeasuresThe International Index of Erectile Function (IIEF), postoperative self-reports, patient satisfaction, and clinical characteristics were used to measure outcomes.MethodsWe retrospectively reviewed charts of 36 patients who underwent surgery for Peyronie's disease requiring grafting from 1999 to 2005. Follow-up to subjectively assess outcomes was conducted.ResultsAverage patient age at surgery was 55 ± 1 years. Body mass indexes were similar among all groups. Erectile dysfunction risk factors were comparable with 36% reporting hypertension and 22% hypercholesterolemia. Overall patient follow-up time was 673 ± 98 days. Self-reported resolution of penile curvature was noted in 60% of dermal, 100% of Tutoplast, and 76.9% of Stratasis graft recipients. Stratasis patients maintained presurgery length (54%) and rigidity (77%) more so than dermal (30%, 60%) and Tutoplast (23%, 39%) patients. Assessment of erectile dysfunction using the IIEF-5 captured significant improvements in patients receiving Stratasis grafts (preoperative: 10.1 ± 1.1 vs. postoperative: 17 ± 1.6). Overall, 89% of patients reported satisfaction following surgical intervention.ConclusionsSurgical management of Peyronie's disease results in correction of penile curvatures and high rates of patient satisfaction. Loss of penile length and decreased rigidity occurred to a lesser degree with Stratasis grafts. While detailed informed consent is essential in this patient population, novel materials such as Tutoplast and Stratasis grafts improve outcomes following surgical correction of Peyronie's disease. Kovac JR, and Brock GB. Surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease.