V04-04: Micro-perforations to correct curvature and fibrosis at the time of penile prosthesis placement
Peyronie’s disease at the time of IPP has classically been managed with 1 of 3 approaches: modeling, incision, and plication. The major drawback is the penile length that was lost is not restored. Herein, I present my technique of micro-perforation approach to maximize length and minimize complications during penile prosthesis placement in men with Peyronie’s disease.
From October 2017 to March 2018, men diagnosed with penile fibrosis or Peyronie’s disease undergoing penile prosthesis were evaluated. These patients underwent a microperforation technique of the Peyronie’s plaque or throughout the penis in cases of fibrosis. Perioperative findings, outcomes, and postoperative complications were evaluated.
10 men were included in the evaluation. Average age was 64 (53-70) and average follow up was 8 months (3-7). Two patients had no curvature, the average curvature in the remaining 8 patients was 60 degrees (35-90). The direction of curvature was dorsal in 6, right in one, left in one, and ventral in one. Operating room time was 115 minutes on average (90-150) and average estimated blood loss was 85 mL (50-175). The operative approach included a long ventral incision in one, degloving in three, and penoscrotal invagination in six. Wound complications occurred in three patients: two in the degloving approach, and one in the long ventral incision. One had prolonged glandular and coronal edema, one had a delayed incisional breakdown at 3 months, and the patient in the ventral degloving incision had a separation that healed by secondary intention. All were managed conservatively. Average pre-incision stretched length was 8.4cm (7-10), post incision stretch length was 10.7cm (8-12); average increase in length was 2.2 cm (1-3). Final curvature was <10 degrees in all patients. Device issues were encountered in two patients, one patient had a device leak after 2 months, and another had auto-inflation requiring revision of the reservoir. Coloplast Titan (Minneapolis, USA) was used in 4 patients; AMS CX in 4 and LGX (Minnetonka USA) was used in 2 patients each. </p>
Micro-perforation, with tachosil application, resulted in increased length, and resolution of curvature without significant perioperative complication. Wound complications were more common with the degloving, and ventral incision approach versus the invagination approach. Further investigation and follow up will be needed to determine the long term efficacy.