Penile straightening maneuvers employed during penile prosthesis surgery: technical options and outcomes

Abstract

Straightening maneuvers (SM), including manual penile modeling, tunical relaxing incisions and corporal reconstruction using grafting techniques, are occasionally required during inflatable penile prosthesis (IPP) implantation to ensure functional penile straightness. The aim of this study was to compare the outcomes of men undergoing SM employed during IPP implantation compared with those wherein these maneuvers were not required. A retrospective review of 391 patients undergoing IPP implantation at the Johns Hopkins Hospital from January 2000 to December 2011 was performed. Patients in whom some SM was employed (SM, n=93, 23.9% of the overall cohort) were compared with those for whom SM was not required (IPP group, n=298). Seven patients were excluded from final analysis (6 patients with IPPs inserted in neophalli (SM group), and 1 patient with incomplete data (IPP group). Patients in whom a SM was used were younger (55.4 vs 62.3 years), more likely to have Peyronie's disease, and less likely to have prostate cancer, radical prostatectomy or to have previously used erectile aids (all P<0.05). Mean operating room time in the SM group was longer (173.8 vs 152.9 min, P=0.003). Within the SM group, modeling was performed in 40 (43%), tunical relaxing incisions in 37 (39.8%) and tunical reconstruction in 16 (17.2%) (most commonly using allograft dermis or pericardium, or synthetic gore-tex grafts). There were no significant differences in terms of device infection (P=0.15), mechanical failure (P=0.23) or erosion (P=0.96). Although limited in size, this cohort study suggests that IPP implantation in men with penile deformity requiring complex reconstruction to achieve straightening may be done proficiently and without increased adverse outcome risk.

Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function

“…In patients with mild curvature (less than 30°), a PPI alone may result in satisfactory straightening of the penis. However, for men with considerable residual penile curvature (greater than 30°) following the placement of a PPI, other options, such as manual modelling, penile plication, and/or plaque incision with or without grafting, should be undertaken at the time of surgery [2122]. Manual penile modelling can be performed with the prosthesis fully inflated by bending the penile prosthesis in the contralateral direction to the curvature for a short period of time ( e.g.…”

Penile Prosthesis Implantation in an Exstrophy-Epispadias Complex Patient: A Case Report

“…Additional penile modeling maneuvers were used to achieve further straightness of the penis. 2 The relaxing incisions produced a minimal defect <1 cm, which did not require a patch. A glanulopexy was performed to correct his glans hypermobility.…”

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

“…Other human studies using HCP compared the result of the pericardial graft with other substitutes (i.e., dermal grafts, penile remodeling, or tunica albuginea plication). There were no detailed results in 2 studies for comparing the pericardial graft with other graft materials [35,44]. Pooled results using the fixed-effects model revealed that there were no significant differences between HCP and other substitutes regarding the rate of dissatisfaction, glans hypoesthesia, and penile shortening at the last follow-up.…”