Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation

Lucas, Jacob; Gross, Martin; Barlotta, Ryan; Sudhakar, Architha; Hoover, Christopher R.V.; Wilson, Steven K.; Simhan, Jay

doi:10.1016/j.urology.2020.08.055

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…9 Lucas et al corroborated this technique in a study in which 40 PD patients had a preoperative mean curvature of 47.8° and a postmodeling mean curve of 10.6°, with no urethral nor prosthetic complications. 4 The utilization of an IPP may be more e cacious than a MPP implant for the treatment of PD. In a 2011 study, Garaffa et.…”

Section: Optimal Modeling: Updated Methods To Eliminate Curvature Dur...mentioning

confidence: 99%

“…noted that only 29% of patients required additional curvature procedures after penile prosthetic (PP) placement. 4,5 PP placement without manual modeling (MM) can be used to correct penile curvature in patients who have less than a 30° curvature, as the PP alone acts an internal tissue expander to correct the penile curvature over time. 5 However, residual curvature may exist after PP placement, and adjunctive intraoperative maneuvers may be necessary to reduce the curvature within normal limits.…”

Section: Introductionmentioning

confidence: 99%

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Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie’s disease patients

Conlon

Herzog

2023

Int J Impot Res

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With the advent of new surgical techniques to treat Peyronie's disease with concomitant erectile dysfunction, there remains a question of whether manual modeling, an older technique, still has a place in the treatment algorithm within penile prosthesis surgery. While the implantation of a penile prosthetic often corrects moderate to severe curvature, penile curvature, in some cases, remains greater than 30°. In these cases, manual modeling should be the rst line of treatment for persisting intraoperative penile curvature after the placement of a penile prosthetic due to its long-term e cacy, noninvasive approach, and lack of adverse effects.

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Section: Optimal Modeling: Updated Methods To Eliminate Curvature Dur...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie’s disease patients

Conlon

Herzog

2023

Int J Impot Res

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“…In a recent study by Lucas et al , they sought to optimize the modeling procedure. Their results showed a mean preoperative curvature of 47.8 degrees and a mean postoperative curvature of 10.6 degrees, a significant decrease in all 40 patients requiring additional straightening following IPP insertion ( 20 ). They also suggested that by applying significant glandular pressure, urethral perforation can be avoided, as no complications were observed in their procedure, potentially correcting a weakness in the original method presented by Wilson and Delk ( 19 , 20 ) ( Figure 3 ).…”

Section: Modelingmentioning

confidence: 98%

“…Their results showed a mean preoperative curvature of 47.8 degrees and a mean postoperative curvature of 10.6 degrees, a significant decrease in all 40 patients requiring additional straightening following IPP insertion ( 20 ). They also suggested that by applying significant glandular pressure, urethral perforation can be avoided, as no complications were observed in their procedure, potentially correcting a weakness in the original method presented by Wilson and Delk ( 19 , 20 ) ( Figure 3 ). Wilson et al later performed a long-term follow-up of their initial cohort, finding no significant difference in the penile prosthetic survival rate between modeling and non-modeling groups, concluding no significant damage was done by the modeling process ( 21 ).…”

Section: Modelingmentioning

confidence: 98%

Inflatable penile prosthesis placement in Peyronie’s disease: a review of surgical considerations, approaches, and maneuvers

Good,

Crist,

Henderson

et al. 2024

Transl Androl Urol

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Peyronie’s disease (PD) is a fibrotic disorder of the tunica albuginea that results in penile deformity and/or curvature. Patients usually present complaining of penile pain, shortening and deformity resulting in dissatisfaction with intercourse. Many patients with PD will present with concomitant erectile dysfunction (ED). This disease is a significant concern for patients as it impacts both sexual function and overall quality of life. While there are several interventions available for PD treatment, inflatable penile prosthesis (IPP) implantation is considered the gold standard approach for those with moderate to severe concomitant ED, refractory to medical therapy. The goal of treatment is to give a man a functionally straight erection. Placement of an IPP alone may achieve this. However, when curvature still exists, several adjunct procedures may be performed to include manual modeling, plication, plaque incision or excision and grafting. Additionally, advanced lengthening procedures may also be used. In this paper we will present a comprehensive review of the adjuvant straightening techniques that can be used during IPP placement in men with PD and refractory ED when curvature still exists. Patient selection is a key predictor of implant success, as is preoperative and postoperative management to optimize overall patient care and satisfaction. These topics along with the different surgical approaches to IPP insertion for PD will also be discussed, including the benefits and shortcomings of each. A flowchart to aid surgeons in their intraoperative decision making based on curvature characteristics and specific patient concerns is presented.

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“…Additionally, modeling of the crooked penis after PPI is not obsolete as an adjunctive procedure (11). Recently it is showed that optimal modeling could be both safe and effective in cases of moderate-severe penile curvature, precluding the need for more time-consuming and complex surgical procedures (12).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Residual curvature correction during penile prosthesis implantation (PPI) is usually needed in patients with severe erectile dysfunction (ED) and concomitant Peyronie's disease (PD). The aim of the study was to assess the different existing techniques for treating residual penile curvature during PPI in patients with severe PD and ED. We generated a comprehensive narrative review of the literature until August 2020 on the use of PPI in combination with straightening reconstruction techniques, in treating patients with severe PD and ED. We included studies published in English, assessing the PPI as primary intervention in patients with PD and ED. Secondary research studies and studies with insufficient data were excluded from final analyses. We included a total of 33 clinical articles with 1,612 patients that assessed the effects of PPI combined with straightening surgical techniques for the treatment of severe PD and ED. Based on the severity of penile curvature, the concomitance of additional penile deformities (i.e., hourglass deformity), the penile length, the presence of previous penile operations and the surgeon's experience, four main categories of surgical techniques were identified: (I) PPI with plication of the penis on the convex side of the curvature, (II) transcorporeal plaque incision/excision, (III) PPI with plaque/tunical incision(s) on the concave side of the curvature and (IV) PPI with plaque incision/excision plus grafting. Patients with severe PD and ED can expect excellent outcomes with PPI and surgical correction of residual penile curvature and minimal side effects. Overall, all the above techniques seem to able to correct the residual penile curvature during prosthesis implantation. Grafting techniques seem to be favorable in patients with additional severe penile shortening. Still, no definite conclusions can be drawn regarding the superiority of one technique over the other.

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Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation

Cited by 9 publications

References 24 publications

Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie’s disease patients

Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie’s disease patients

Inflatable penile prosthesis placement in Peyronie’s disease: a review of surgical considerations, approaches, and maneuvers

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

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