A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease

Levine, Laurence; Dimitriou, RJ

doi:10.1038/sj.ijir.3900515

Cited by 101 publications

(79 citation statements)

References 9 publications

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“…For tunical defects greater than 2 cm, polytetrafluoroethylene patch grafting was performed to prevent prosthesis cylinder herniation and recurrent deformity from cicatrix contraction. Full erectile capacity with a straight phallus was achieved in all patients [42].…”

Section: Indicationsmentioning

confidence: 98%

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

Sadeghi‐Nejad

2007

The Journal of Sexual Medicine

109

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Introduction Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases. Aim This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery. Methods A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery. Main Outcome Measures Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications. Results Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices. Conclusion Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures.

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Section: Indicationsmentioning

confidence: 98%

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

Sadeghi‐Nejad

2007

The Journal of Sexual Medicine

109

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“…23,25,28 This allows for correcting the deformity while addressing the ED as well. If curvature is not satisfactorily corrected after the prosthesis is inflated at the time of placement, additional straightening maneuvers may be performed.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

“…It is recommended that if the incisional defect is greater than 2 cm in any dimension, then a biograft should be placed over the defect to prevent cicatrix contracture of the incision or herniation of the prosthesis (Box 4). 28 …”

Section: Preoperative Evaluationmentioning

confidence: 99%

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Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

112

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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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“…Although malleable prostheses have been used, longterm satisfaction rates are lower than with inflatable devices [131][132][133][134][135][136]. 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.…”

Section: Penile Prosthesis Implantationmentioning

confidence: 98%

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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A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease

Cited by 101 publications

References 9 publications

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

Surgery for Peyronie's disease

Treatment of Peyronie’s Disease: 2012 Update

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