Management of Peyronie's disease with penile prostheses

Abstract

Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.

Addressing residual penile deformity in the Peyronie’s disease patient during penile implant surgery

“…The rate of this complication is 4% and requires removal of the offending cylinder. The current experience of these authors supports the conclusion that modeling of the penis over an inflated penile prosthesis causes no increase in the risk of mechanical malfunction or reoperation when compared with patients who have prosthesis insertion without an additional modeling maneuver [20,25].…”

“…When the residual curvature is greater than 20° to 30° after the modeling maneuver, multiple, small incisions adjacent to the apex of the curvature can be performed [25]. Electrocautery can be safely used for the tunical incision with any underlying inflatable cylinder provided that the cylinders are deflated and the electrocautery coagulation set to less than 35 W. To further protect the cylinders, electrocautery should also be applied only to the external tunical layer and not to the whole thickness of the tunica [26].…”

Enfermedad de Peyronie

“…Se pueden utilizar prótesis maleables, rígidas o semirígidas. En algunos casos la colocación de la prótesis debe ir precedida de técnicas quirúrgicas como la de Nesbit (16) .…”

Peyronie's disease: a critical appraisal of current diagnosis and treatment

“…Incision of plaque followed by graft is one effective approach. 110 The technique of 'modeling' the fully inflated prosthesis is successful (90%) in straightening the penis, but is associated with a risk of urethral injury (4%). 111 Satisfaction rates in the overall population of men who receive penile prostheses are in the range of 90%; 112 however, men with PD may have somewhat lower satisfaction rates (73-75%).…”