V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE

Abstract

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE Giovanni Chiriaco, Enya Maher, Wai Gin Lee, and David Ralph Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Enya MaherEnya Maher More articles by this author , Wai Gin LeeWai Gin Lee More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing. This video highlights strategies that will aid the implanter when faced with these intraoperative challenges. METHODS: This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (>30°) following moulding. TachoSil sealant matrix was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation. RESULTS: All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery. CONCLUSIONS: Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including TachoSil or bovine pericardium. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Chiriaco More articles by this author Enya Maher More articles by this author Wai Gin Lee More articles by this author David Ralph More articles by this author Expand All Advertisement Loading ...