Nondegloving technique for Peyronie′s disease with penile prosthesis implantation and double dorsal-ventral patch graft

Abstract

A circumcising incision to deglove the penis for penile prosthesis (PP) implantation can increase the risk of ischemic injury to the glans penis. In order to avoid vascular complications, we describe a novel technique utilizing a ventral incision to perform the PP implantation and a double-dorsal patch graft, or “sliding technique” (ST), in patients with severe Peyronie's disease (PD). Three patients with severe PD and erectile dysfunction at our institution underwent ST and PP implantation through a ventral incision. This new approach was not only successful in facilitating the ST and PP implantation in these patients but also allowed for adequate exposure of the penile shaft with no reported loss of sensation. We also conducted a review of current literature regarding the approaches for PD. While ischemic complications of PP implantation and ST are rare, there are reports of ischemic injury in patients undergoing a circumcising incision. The combination of a circumcising incision and a patient's underlying peripheral artery disease potentially raises a patient's risk of this rare complication. Our innovative ventral incision provides an alternative method for PP implantation and ST in order to avoid ischemia of the penis, while still allowing for adequate exposure.

A comprehensive narrative review of residual curvature correction during penile prosthesis implantation in patients with severe erectile dysfunction and concomitant Peyronie’s disease

“…Only 11 articles were published until 2010 (14,16,(24)(25)(26)(27)(31)(32)(33)(34)(35). Most of the articles were published during the last decade (17)(18)(19)(20)(21)(22)(23)(28)(29)(30)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Most studies had a retrospective design and only five studies were prospective (21,24,27,41,43).…”

“…A total of 5 studies with 69 patients investigated the PPI in combination with a plication technique for the correction of residual curvature (Table 1) (16)(17)(18)(19)(20). All records had the limitation of a relatively small sample size, with the largest cohort recruiting only 30 participants (19).…”

“…In all studies, 3-piece inflatable penile prostheses were implanted, and individuals were followed up for about 12 months. In studies reporting the plication technique performed, patients were treated with a longitudinal penile shaft incision without degloving (17,18,20). A series of parallel, 2-0 non-absorbable polyester sutures (1-5 pairs) were used when simple plication without tunical incision was preferred.…”

“…Nineteen studies investigated the results of PPI with additional tunical/plaque incision/excision and grafting of the defect for the correction of severe residual penile curvature (Table 4) (14,20,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). They included a total of 1,072 patients with a pooled mean age of 59.8 years (ranged from 51.2 to 67.2) and a pooled mean follow-up of 27 months (ranged from 6.6 to 45 months) (14,20,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Most studies assessed the use of inflatable 3-piece penile prosthesis (14,20,31,38,(42)(43)(44)(45)47)...…”

Contemporary surgical and non-surgical management of Peyronie’s disease

“…Fang et al later presented a variant of this procedure whereby a large ventral incision could be retracted laterally, then dorsally to expose the corpora and allow sliding incisions as well as IPP placement without degloving. They reason that degloving confers an unnecessary risk of ischemic damage to the glans and can thus be avoided with this simple and effective modification ( 84 ).…”