Sliding technique through a non-degloving approach for Peyronie's Disease: 2-surgeon experience

Abstract

ABSTRACT Introduction The sliding technique (ST) has been used to restore penile size in patients with penile atrophy secondary to severe Peyronie's Disease (PD) and erectile dysfunction (ED). When combined with degloving, this procedure carries a potential risk of causing ischemia or necrosis to the glans penis. Objective We hereby present a detailed surgical technique of the non-degloving approach for the ST and penile prosthesis (PP) placement. Methods Retrospective review of databases from 2 surgeons and report patient outcomes after PP placement with sliding technique for the correction and size restoration of severe PD and ED from January 2015 to September 2019. Results A total of 39 patients had significant penile atrophy and/or curvature >60 degrees and underwent PP placement with grafting procedures between 2 surgeons. 11 of those patients underwent ST of which 9 had the procedure performed through a non-degloving ventral incision. Mean degree of curvature prior to ST was 62 degrees (45 to 90 degrees) Mean penile length gain was 2.47 cm (2.0 to 3.0 cm). At a mean follow up of 12.4 months (3 to 31 months) only 1 patient had residual curvature, which was minimal at 15 degrees. There were no infections or vascular complications in our series. Conclusion There are reports of ischemic injury in PD patients undergoing penile prothesis placement in addition to the ST with a circumcision and penile degloving. The non-degloving technique with a ventral incision provides for an alternative method to perform the ST in patients with penile atrophy secondary to severe PD and ED. This approach could theoretically minimize the risk of glans ischemia by maintaining dartos and skin continuity to the glans penis while still allowing for adequate surgical exposure. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Jonathan Clavell Hernandez: Consultant for Coloplast and Boston Scientific, Run Wang is consultant for Boston scientific and Coloplast ).