V12-12: REAL PENILE LENGHTENING AND WIDENING IN PEYRONIE’S DISEASE: CIRCULAR AND LONGITUDINAL GRAFTING WITH SIMULTANEOUS PENILE IMPLANT
In severe cases, Peyronie's disease has been associated with penile shortening and narrowing combined with erectile dysfunction. The goal of surgical treatment is restoration, and if possible additional enlargement of penile length, girth and shape by grafting and simultaneous implantation of penile prosthesis.
Surgical approach used was ether complete degloving by subcoronal circular incision and exposure of Buck’s fascia and tunica albuginea or penile eversion thru penoscrotal incision and direct approach to the tunica albuginea without dividing Buck’s and Daros fascia. _x000D_ Urethra was mobilized taking care to preserve its Buck’s fascia. _x000D_ Intraoperative measurement of penile deformity was done in full artificial erection. Penile shape was estimated by artificial erection and all deformities are corrected by transversal or longitudinal incision of albuginea and grafting, using geometrical measurement and calculation. Additional circular incision and grafting were done for additional penile lengthening. In patients who required penile widening, 2 longitudinal lateral incisions of albuginea were done with grafting by hernia mesh. Inflatable penile implant is inserted on a classical way, and wound/s closed. Suction drainage was placed in all patients for 2-3 postop days. Prosthesis was left semi-inflated for 2-3 weeks postoperatively, when cycling was started with advice to keep it inflated as long as possible during the day and overnight. _x000D_ Vacuum physiotherapy was advised for 5-6 months postoperatively to additionally stretch the grafts and gain maximal penile size.
Follow?up was 13 months. Penile length gain is 2.2cm and girth gain 1.9cm comparing to the penile size before Peyronies disease. Patient had transitory prepuce swelling and reported mild transitory postoperative numbness.
Total tunica reconstruction by transversal and longitudinal grafting with simultaneous penile prosthesis implantation is complex, but the only present procedure that gan provide real penile augmentation.