Inflatable penile prosthesis with plaque incision and grafting with TachoSil for Peyronie’s disease (PICS Technique)

Abstract

Background: Residual curvature correction during inflatable penile prosthesis (IPP) implantation in patients with Peyronie’s disease (PD) is common. The PICS Technique, that is plaque incision and grafting with the self-adhesive TachoSil ® (Baxter, CA, USA), is a novel option to address residual curvature in these cases. In order to understand the surgical technique and improve surgical outcomes the urologist should follow a standardized approach. The aim of this study is to provide tips and tricks for the PICS Technique. Methods: The present study offers a step-by-step tutorial for the PICS Technique. The author describes his surgical technique in detail and provides important aspects and tips one has to be aware of when performing the PICS Technique. Surgical videos will highlight the most important steps during the approach. Indications to perform this technique will also be presented. Moreover, postoperative management strategies will be discussed. Results: The PICS Technique can be applied when residual curvature is >40° after insertion of the IPP. Important steps include penile degloving, opening of Buck’s fascia and mobilization of the neurovascular bundle. The device is then inflated, and plaque incision is performed at the point of maximum curvature. The defect of the tunica albuginea is then closed/sealed with the TachoSil ® , which does not require suture fixation. Finally, Buck’s fascia and the penile skin are closed. Postoperatively, the device is left inflated 40–50% for a period of 4 weeks. Sexual intercourse is possible 6 weeks following the surgical procedure. Close follow-up is recommended in order to detect possible complications/problems. Conclusions: The present study offers a step-by-step tutorial for the PICS technique, in order to help the reader to understand major steps during the procedure and to avoid pitfalls. The surgical videos help visualization of crucial surgical steps. A standardized approach and adequate postoperative management are main predictors for success and patient satisfaction.