Penile Prosthetic Surgery for Peyronie's Disease: Defining the Need for Intraoperative Adjuvant Maneuvers

Abstract

There are a number of accepted approaches to the patient with Peyronie's disease and erectile dysfunction (ED), including penile prosthesis surgery. During prosthesis surgery for Peyronie's disease some men are left with residual curvature upon maximum device inflation. This analysis was undertaken to define how often and in which patients, intra-operative adjuvant maneuvers are required. Men undergoing penile prosthesis surgery for combined Peyronie's disease/ED constituted the study population. Residual curvature >10 degrees was deemed to warrant the use of a secondary maneuver to correct curvature. In this analysis, plaque release incisions were utilized and grafting was performed only if there was overt exposure of the prosthesis. 36 men were included in the analysis. All patients with preoperative curvatures <or=30 degrees had complete resolution of the penile curvature with full inflation of the prosthesis alone. Of patients who had >45 degrees curvature preoperatively, 86% needed plaque incision to achieve adequate penile straightening. Grafting was required in only 5.5% patients and both of these patients had preoperative curvature >60 degrees . In 61% of patients with combined Peyronie's disease/ED in this study, the placement of a three-piece inflatable penile prosthesis alone corrected the penile curvature. 86% of patients requiring plaque incision had preoperative curvatures >45 degrees . This information should enable surgeons to plan such operations more effectively and to counsel patients more comprehensively prior to operative intervention.