Primary erectile dysfunction

Abstract

PurposePatients with primary erectile dysfunction (ED) are unable to report on the possibly existing congenital penile curvature. Curvature is recognized only after implantation, in which case the implant can be extracted and its length modified or the curvature corrected, adding to the complexity of the procedure and the risk of infection. This study describes a method to evaluate congenital curvature in cases of primary ED before surgery and to correct curvature upon prosthesis implantation, even before calibration of the corpora cavernosa. Materials and methodsBefore prosthesis implantation, artificial erection is induced by basal compression and saline infusion, demonstrating curvature, if any. Surgery is performed through a penoscrotal incision. One or more cruciate corporotomy incisions are cut over the point of maximum curvature, straightening the penis. Full correction is checked by covering the corporotomy with sterile surgical glove material sutured to its edges and by reinducing artificial erection. Dilatation of the corpora, calibration, and implantation proceeds as usual and the corporotomies are sealed by a tunica vaginalis graft. ResultsCurvature was demonstrated in nine out of 16 cases, necessitating correction in four, in whom curvature was fully corrected and prosthesis was successfully implanted and followed for 6-8 months. ConclusionCongenital curvature can coexist with primary ED (nine out of 16 patients in this series); yet, it is not reported by the patient who has never experienced a rigid erection sufficient to reveal the curvature. Preoperative detection of curvature is of value for patient counseling and planning of the procedure. Correction of curvature before implantation (in the same session) can help implanting the suitable length of prosthesis in a straight penis, without undue complexity and risk of infection.