The management of residual curvature after penile prosthesis implantation in men with Peyronie’s disease

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To report our experience in the management of residual curvature after implantation of a penile prosthesis in men with Peyronie’s disease (PD). PATIENTS AND METHODS • From January 1985 to June 2009, 62 (29%) of the 209 patients with PD that have undergone the insertion of a penile prosthesis have required an additional straightening procedure to correct the residual curvature after the insertion of the cylinders of the implant. • The types of additional manoeuvres, their success in correcting the residual curvature and eventual complications have been reported. RESULTS • Among the additional straightening procedures, modelling was more successful in achieving straightening when performed on an inflatable device (84%) than on a malleable implant (54%). • If the curvature persisted after modelling or if the curvature was ventral, straightening was achieved with tunical plications or incision with or without grafting. CONCLUSION • Although it is common for the simple implantation of cylinders alone to straighten the penis, some patients will present a residual curvature that must be successfully corrected with additional straightening procedures.

Intraoperative Decision-making for Precise Penile Straightening During Inflatable Penile Prosthesis Surgery

“…4,9 Overall, 19%-42% of PD/ED patients will require adjunctive straightening procedures after cylinder implantation. 10,11 Some implanters prefer to perform an artificial erection before beginning every case, as this identifies any penile deformities before the cylinders are implanted. However, only 7% of our IPP patients needed correction of their curvature, and adding this additional step to every procedure would significantly increase operative time and procedural costs, with no benefit to the vast majority.…”

“…13,[17][18][19] In cases of severe (>60 ) curvature, complete plaque excision with or without a graft has also been reported. 11 These complex repairs necessitate removal of the cylinders to avoid damage and can require significant additional operative time and multiple or longer incisions. We have avoided grafting in this setting because of concerns about graft shrinkage and the potential for device infection near a foreign body.…”

Recent surgical advances in Peyronie’s Disease

“…Plaque stabilization is characterized by fibrosis, dystrophic calcifications, and rarely, ossification. 10 It is during this stage that surgical intervention occurs. An history of penile trauma must be sought (reported in 5% -13% of cases) 5 as well as Dupuytren's contracture (associated risk of 3% -22 % of PD), Ledderhose disease and tympanosclerosis.…”

“…51 Penile prosthesis alone can correct the curvature in almost 70% of patients. 52 Both malleable and inflatable penile prostheses (IPP) have been used with worst results from the latter. 21 Patients with extended circumferential plaques and severe corporal fibrosis may need additional surgical dilators (Rossello ® cavernotomes or the Otis ® urethrothomes).…”

“…Grafting is recommended for tunical defects greater than 2 cm preventing prostheses herniation. 10,57 There are currently two companies marketing IPP: American Medical Systems (AMS) and Coloplast. Both the AMS 700 CX ® and the Coloplast Titan ® seem to be similar when it comes to associated technical problems or patient satisfaction.…”