Simultaneous Penile Lengthening and Penile Prosthesis Implantation in Patients with Peyronie’s Disease, Refractory Erectile Dysfunction, and Severe Penile Shortening

Abstract

Introduction Due to loss of length, patients who had penile prosthesis implantation for Peyronie’s disease (PD) show a statistically significant reduction in their levels of satisfaction when compared with the general implant population. Aim The aim of this study is to report our experience of penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD and severe penile shortening. Methods Between March 2006 and February 2008, 23 patients with PD, refractory erectile dysfunction, and severe penile shortening underwent penile lengthening with circumferential graft and concomitant implantation of an inflatable penile prosthesis. Main Outcome Measures Surgical outcome and complications have been recorded during postoperative follow-up. Patients’ satisfaction has been assessed 6 months postoperatively with the administration of the modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire. Results After an average follow-up of 22 months (range 6–36), 20 patients attended all the postoperative follow-up visits and returned the EDITS questionnaire. An average length gain of 2.8 cm (range 2.2–4.5) was recorded, and all patients were able to cycle the device and engage in penetrative sexual intercourse. Patient recorded complications included diminished glans sensitivity in four (20%) and persistent dorsal curvature of less than 15° in three (15%). Overall, 18 patients (90%) were satisfied with the cosmetic and functional result of surgery. Conclusion Penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD represents a safe and reproducible technique that yields higher satisfaction rates than penile prosthesis implantation alone in patients with severe penile shortening.

Satisfaction and complications with the Titan® one-touch release penile implant

“…In this regard it is important to note that many conditions that cause ED can also reduce penile size. This may be the case with prostatectomy patients and Peyronie's patients, where fibrosis can shorten the tissue [11,12], but may also be seen with obesity, where pubic fat makes the penis look shorter [2]. It can also be speculated that some patients may have a recall bias regarding their penile size after long-standing ED.…”

Is the modified sliding technique the way forward in Peyronie's surgery?

“…Initial attempts at penile length restoration involved a full disassembly of the penis and the use of a circumferential graft [4]. Then, in 2012, Rolle et al [5] described the sliding technique, a modification of the circumferential graft that consists of a double dorsal-ventral patch and should therefore provide more stability to the corpora cavernosa than a circumferential graft.…”

A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery

“…Attempting to avoid patient’s complaints of penile shortening after the IPP, some physicians have proposed a more aggressive approach to sizing the cylinder (15), while others have proposed different penile lengthening techniques to be performed concomitantly with the IPP placement (16-18). Obviously, an overly aggressive approach may lead to cylinder aneurysm or fluid loss, or S-shaped deformity (19).…”

“…On the other hand, undersized IPP will lead to dissatisfaction. Likewise, there are case reports of penile sensation decrease after penile implantation (6,16). However, there was no well-designed research to further support the decrease of penile sensation after the IPP placement at the time of this study.…”