Inflatable Penile Prosthesis Placement in Men with Peyronie’s Disease and Drug-resistant Erectile Dysfunction: A Single-Center Study

Abstract

Introduction Erectile dysfunction (ED) frequently accompanies Peyronie’s disease (PD) and changes the therapeutic approach. Aim To evaluate a single-center experience with inflatable penile prostheses (IPP) in men with medication refractory ED and PD. Methods Ninety men underwent placement of an IPP with straightening maneuvers as necessary to address their deformity and ED. Main Outcome Measures Preoperative assessment included International Index of Erectile Function-erectile function domain (IIEF-EF) and duplex ultrasound to confirm ED and measure erect deformity. Postoperative assessment included a modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire, as well as office visits at 1, 6, and every 12 months thereafter. Results Complete chart review was performed with mean follow-up of 49 months. Mean preoperative IIEF-EF score was 11. Full rigidity was not obtained in any patient during duplex ultrasound. Mean curvature at maximum erection was 53°. There were seven mechanical failures requiring device replacement, two revision surgeries for pump or reservoir malposition, one infected device, and two corporoplasties for distal tunica erosion. Postoperative office assessment revealed a functionally straight (i.e., <20°) erect penis and a properly positioned as well as operational device in all patients. The modified EDITS questionnaire was returned by 56 (62%). Overall, 84% of patients were satisfied with their outcome, yet only 73% were satisfied with their straightness. Patient perceived postoperative curvature correction stabilized quickly and was complete by 3 months in 84% of patients. Satisfaction with ease of inflation, deflation, and concealability was 84%, 71%, and 91%, respectively. Coital activity was reported by 91% of men in this group. Conclusion In men with PD and ED, IPP placement allowed reliable and satisfactory coitus for the great majority of men. Mechanical failure was 7%. Men with PD undergoing IPP placement should be counseled regarding potential penile length loss and residual curvature, neither of which appeared to interfere with coitus but may reduce satisfaction.

Surgery for Peyronie's disease

“…78 Although it would appear that for more severe curvature that more advanced techniques will be necessary, published experience has suggested that manual modeling may be used as first-line therapy for correction of curvature after prosthesis implantation. 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.…”

“…Recently Levine et al 78 reported on 90 consecutive men undergoing placement of an inflatable penile prosthesis, with 4% having satisfactory straightening with prosthesis placement alone, 79% having satisfactory curvature correction with prosthesis and modeling, 4% required tunical incision and 12% had incision and pericardial grafting for correction of curvature. It did not appear that the additional maneuvers increased the rate of mechanical failure or infection.…”

“…This may indicate a flaw in the design of the questionnaire, but may also reflect the general disappointment and frustration of patients with PD. 78 Thus, preoperative counseling and setting appropriate expectations as with any prosthesis placement is critical. 81 It is recommended that preoperative discussion is also focused on the goal of obtaining 'functional straightness', in which a residual curvature of 20u or less in any direction would likely not compromise sexual activity.…”

Recent surgical advances in Peyronie’s Disease

“…2 It has become the predominant method utilized in the United States for penile straightening during IPP placement. 56,64,65 If curvature > 30º persists, subsequent plaque-releasing incisions, transcorporeal techniques (transcorporeal incision, scratch procedure) or grafting are also usually needed. Grafting is recommended for tunical defects greater than 2 cm preventing prostheses herniation.…”

Use of a microdebrider for corporeal excavation and penile prosthesis implantation in men with severely fibrosed corpora cavernosa: a new minimal invasive surgical technique

“…[1] Corporeal fibrosis may develop following the explantation of infected penile prosthesis, refractory low-flow priapism, severe penile trauma, penile irradiation, Peyronie's disease, and chronic intracavernosal injection of vasoactive drugs. [1][2][3][4][5][6] In such cases, reinforcement of blind dilatation against a resistance may lead to perforation through the glans or urethra. Because of the problems mentioned above, most surgeons tend to implant smaller cylinders to minimize the complications that probably results in penile shortening of up to 4-6 cm.…”