Inflatable Penile Prosthesis Placement Research Articles

177 Anatomical Predictors of Premature Ejaculation in Patients Undergoing Placement of Inflatable Penile Prosthesis

177 Anatomical Predictors of Premature Ejaculation in Patients Undergoing Placement of Inflatable Penile Prosthesis

027 Single-center, 7-year Experience of Inflatable Penile Prosthesis Revision Surgery

Inflatable Penile Prosthesis (IPP) remains the mainstay for surgical management of erectile dysfunction (ED). Complications such as malfunction, infection and erosion oftentimes require explanation of the prosthesis. The primary aim was to determine the feasibility and efficacy profile of performing revision IPP operations. A single-center, retrospective review of all patients who underwent IPP re-implantation from 2008-2015 were included in our analysis. Age, BMI, original surgery date, etiology of explantation, and re-implantation surgical variables including operative duration, blood loss, hospital duration, and date of activation were recorded for each patient. Feasibility and efficacy were determined by comparing blood loss, hospital duration and date of activation to patients undergoing primary implantation. 57 patients with a mean age and BMI of 68 years and 29.3, respectively, underwent revision IPP placement between 2008 and 2015. 15% (9/57) of patients had a prior history of multiple (>2) IPP surgeries prior to revision surgery at our institution. The date of original implantation ranged from 1977 to 2014. The most common reason for revision was IPP malfunction (pump, reservoir or tubing leak, etc.) at 82.5% followed by infection at 12.3%, exchange from semi-rigid to three-piece IPP at 3.6%, and erosion at 1.8%. Revision surgery resulted in an average blood loss of 44.9, operative duration of 130.2 minutes, and hospital duration of 1.1 days. Time to activation of IPP was approximately 52.7 days.

Synchronous Ipsilateral High Submuscular Placement of Prosthetic Balloons and Reservoirs

IntroductionSynchronous ipsilateral high submuscular placement of artificial urinary sphincter (AUS) pressure-regulating balloons (PRBs) and inflatable penile prosthesis (IPP) reservoirs in a single submuscular tunnel is a novel strategy that could be advantageous for patients who have had major pelvic surgery. AimTo report our initial experience with synchronous ipsilateral vs bilateral placement of AUS PRBs and IPP reservoirs in men undergoing implant surgery. MethodsWe retrospectively reviewed all patients undergoing synchronous AUS and IPP placement from 2007 through 2015 by a single surgeon at our tertiary center. Patients were stratified according to ipsilateral vs bilateral placement of the AUS PRB and IPP reservoir. Main Outcome MeasuresReoperation rates because of infectious or erosive complications and mechanical failure were assessed. ResultsOf the 968 implant surgeries during the study period, 47 men had synchronous device placement, of whom 17 (36%) underwent ipsilateral placement of the PRB and reservoir. During a median follow-up of 19 months (range = 1–84 months), reoperations were necessary in 12 of 47 (26%) and were similar between groups (ipsilateral, 5 of 17, 29%; bilateral, 7 of 30, 23%; P = .73). Most reoperations were due to AUS-related complications (10 of 12, 83%) and nearly all patients with reoperation (10 of 12, 83%) had compromised urethras (ie, prior urethral surgery, radiation, or prior AUS implantation). The most common indication for reintervention was cuff erosion (4 of 47, 9%), with no difference between groups (ipsilateral, 3 of 17, 18%; bilateral, 1 of 30, 3%; P = .13). ConclusionSynchronous ipsilateral high submuscular placement of urologic prosthetic balloons could safely facilitate prosthetic surgery in patients with a history of major pelvic and inguinal surgery.

162 Novel Protective Penile Collar Following Inflatable Penile Prosthesis Placement; the “Wang Collar”

Since the introduction of inflatable penile prosthesis (IPP) into the United States in early 1970s, IPP has become the most effective treatment modality for erectile dysfunction (ED). Post-op care after IPP implantation includes leaving the device partially inflated to preserve penile length and obtain hemostasis. We describe a novel additional post-operative device, the “Wang Collar”. This device is intended to protect the penis in the early post-operative period when the penis is most sensitive with the partially inflated IPP. 121 consecutive patients had the “Wang Collar” included as part of their post-IPP management from August, 2014 to December, 2015. All patients underwent implantation of three-piece IPPs through either penile-scrotal or infrapubic incisions. The device, devised from a polystyrene cup with bottom removed, was secured with tape over the previously dressed and partially inflated penis. The device covered the penis in its entirety, with the urethral catheter emanating from the end of the collar if a Foley was placed. The device was kept in place until post-operative day two and removed along with the remainder of the dressings.

Ectopic Penile Prosthesis Reservoir Placement: An Anatomic Cadaver Model of the High Submuscular Technique

IntroductionHigh submuscular ectopic placement of inflatable penile prosthesis (IPP) reservoirs via the inguinal canal has been popularized as an alternative to the retropubic (orthotopic) location, particularly among men with prior pelvic surgery. Published results suggest minimal complications and high patient satisfaction. However, in our practice, we identified several patients presenting for IPP revision after high submuscular placement who were found to have reservoirs within the peritoneal cavity. AimGiven the potential for complications, we performed a cadaveric study to define the anatomic location of reservoirs placed using this technique. MethodsWe utilized 10 fresh male cadavers without embalming. Bilateral ectopic reservoir placement (10 AMS Conceal [Boston Scientific, Marlborough, MA] and 10 Coloplast Cloverleaf [Coloplast Corp, Humlebaek, Denmark]) was performed using the high submuscular technique via a penoscrotal incision. Strict adherence to published reports detailing the technique was emphasized to assure reliability of findings. Main Outcome MeasuresAnatomic dissection was performed to identify reservoir location within the abdominal wall layers. ResultsTwenty IPP reservoirs were placed without difficulty or concern for inadvertent malpositioning. Sixteen reservoirs (80%) were found anterior to the transversalis fascia, including 7 (35%) deep to the rectus muscle and 9 (45%) deep to the external oblique fascia and lateral to the rectus muscle belly. Two reservoirs (10%) were identified in the retroperitoneal space, while 1 (5%) was preperitoneal (deep to transversalis fascia) and 1 (5%) was intraperitoneal. ConclusionPlacement of IPP reservoirs using the high submuscular technique results in variable anatomic locations, including within or immediately superficial to the peritoneal cavity. Given the lack of immediate recognition and risk of delayed complications with suboptimal reservoir placement, further studies are mandated to assess the long-term safety of the technique.

Risk Factors for Removal or Revision of Penile Prostheses in the Veteran Population

To identify comorbid conditions that may increase the likelihood of revision surgery after primary penile prosthesis implantation. To evaluate trends in utilization of prostheses and selection of device within the Veterans Affairs (VA) system. A retrospective review of the VA Informatics and Computing Infrastructure database was performed using Current Procedural Technology codes to identify any Veteran who underwent penile prosthesis surgery between January 2000 and December 2013. Age, race, procedure type, and relevant comorbidities were identified and compared between groups. A total of 6586 patients underwent primary penile prosthesis placement with at least 1 year of follow-up. Peripheral vascular disease (P <.001), smoking (P <.001), hypertension (P = .012), and history of prostate cancer (P = .043) were each associated with a significant increased risk of revision or removal surgery. There was an increase in overall number of implants placed during the study and increased durability with malleable penile prosthesis (MPP), but there was a downward trend in the number of MPP placed relative to inflatable penile prosthesis (P <.001). MPP were more likely to be placed with increasing age (P <.05) and there was a trend toward increased MPP placement in African Americans compared with Caucasians (P = .06). Peripheral vascular disease, hypertension, smoking, and history of prostate cancer are associated with increased risk for secondary surgery. This raises a provocative question of how vascular insufficiency may play a role in the likelihood of secondary surgery after penile prosthesis placement. Utilization of penile prosthesis placement in the VA system is steadily increasing, most notably with increased numbers of inflatable penile prosthesis placement.

Lengthening strategies for Peyronie's disease.

Loss of penile length is a common complaint of men with Peyronie’s disease (PD), both before and after corrective intervention, which has a significant negative effect on patient quality of life. We sought to identify and describe the methods by which penile length can be preserved or increased. We conducted an extensive, systematic literature review, based on a search of the PUBMED database for articles published between 1990 and 2015. Articles with the key words “Peyronie’s disease”, “penile length” and/or “penile lengthening” were reviewed if they contained subjective or objective penile length outcomes. Only English-language articles that were related to PD and penile size were included. We found no evidence in the literature that medical therapy alone increases penile length. Classic inflatable penile prosthesis (IPP) placement, plication procedures, and the Nesbit procedure appear likely to maintain or decrease penile length. Plaque incision (PI) and grafting appears likely to maintain or increase penile length, but is complicated by risk of post-operative erectile dysfunction (ED). There are several surgical procedures performed concomitantly with IPP placement that may be suitable treatment options for men with comorbid ED, and consistently increase penile length with otherwise good outcomes concerning sexual function. These include the subcoronal penile prosthesis (scIPP), Egydio circumferential technique, the sliding technique, the modified sliding technique (MoST), and the multiple slice technique (MuST). In addition, adjuvant therapies such as penile traction therapy (PTT), post-operative inflation protocols, suspensory ligament relaxation, lipectomy, and adjuvant medical therapy for glans engorgement appear to increase subjective and/or objective penile length for men at high risk of decreased penile length after PD surgery. Considering the psychological burden of length loss in men with PD, providers with adequate volume and expertise should attempt, if possible, to maintain or increase penile length for men undergoing surgical intervention. There are several evidence-based, safe, and effective ways to increase penile length for these men and multiple emerging adjuvant therapies that may help ensure adequate length.

148 “The Wang Collar:” A Novel Post Operative Device after Inflatable Penile Prosthesis Placement

148 “The Wang Collar:” A Novel Post Operative Device after Inflatable Penile Prosthesis Placement

150 A Streamline Approach to Inflatable Penile Prosthesis Placement

150 A Streamline Approach to Inflatable Penile Prosthesis Placement

Active Polysubstance Abuse Concurrent With Surgery as a Possible Newly Identified Infection Risk Factor in Inflatable Penile Prosthesis Placement Based on a Retrospective Analysis of Health and Socioeconomic Factors.

Since the introduction of inflatable penile prostheses (IPPs), risk of infection has decreased. However, concurrent substance abuse has not been investigated in prosthetic urology. To determine whether substance abuse would stand out as a relevant risk factor for infection in patients undergoing IPP implantation. This retrospective study was conducted on charts from the past 12 years at our institution, where a single surgeon completed 602 primary IPP surgeries, with only 12 cases (2%) resulting in postoperative infection. Five of these patients (42%) were actively misusing at least one substance at the time of operation (ie, alcohol, marijuana, cocaine, heroin, other illicit substances, and prescription narcotics). Substance abuse was identified in the medical chart by International Classification of Diseases, Ninth Revision code or by clear documentation by a provider. Multivariate logistic regression analysis was used to estimate the probability of infection as a function of demographic, physical, and treatment variables. Logistic regression analysis was used to determine statistically significant correlations between risk factors and IPP infection. Polysubstance abuse, poorly controlled blood sugar, and homelessness at the time of procedure positively correlated with postoperative infection. Use of the mummy wrap correlated with decreased infection. Active polysubstance abuse, poor glycemic control, and homelessness increase infection risk at IPP implantation. We encourage other implanters to discuss active polysubstance abuse with their patients and to tread cautiously because of the increased risk of infection.

V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2016V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE Paul H. Chung, Ryan J. Flemons, and Allen F. Morey Paul H. ChungPaul H. Chung More articles by this author , Ryan J. FlemonsRyan J. Flemons More articles by this author , and Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Twenty to thirty percent of patients with Peyronie’s disease have erectile dysfunction refractory to medical therapy. We present clinical outcomes of inflatable penile prosthesis (IPP) placement with synchronous penile plication for the simultaneous correction of Peyronie’s disease and erectile dysfunction. METHODS Patients receiving IPP placement with synchronous penile plication were reviewed. After induction of an artificial erection through saline intracorporal injection, plication was performed through a penoscrotal incision retracted distally along the penile shaft as needed for correction. IPP placement was then conducted through the same incision. RESULTS 27 patients with dorsal, lateral, or biplanar curvature with a mean age of 63 years underwent IPP with synchronous penile plication from 2010 to 2015. Mean pre-op curvature was 37 degrees corrected to <5 degrees after plication. A mean of 4 sutures (range 3-6) were used for PP with each suture providing a mean correction of 8 degrees. No patient suffered post-operative complications and all patients were discharged home on post-operative day one. Upon follow up, three patients reported residual curvature; however, no patient reported continued pain or required release of plication sutures. CONCLUSIONS IPP placement with synchronous penile plication is a reliable option for correction of erectile dysfunction and Peyronie’s disease. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e466 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paul H. Chung More articles by this author Ryan J. Flemons More articles by this author Allen F. Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP59-18 SYNCHRONOUS IPSILATERAL HIGH SUBMUSCULAR PLACEMENT OF PROSTHETIC BALLOONS AND RESERVOIRS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma1 Apr 2016MP59-18 SYNCHRONOUS IPSILATERAL HIGH SUBMUSCULAR PLACEMENT OF PROSTHETIC BALLOONS AND RESERVOIRS Nicholas Kavoussi, Ryan Mooney, Jeremy Scott, Billy Cordon, Matthias Hofer, and Allen Morey Nicholas KavoussiNicholas Kavoussi More articles by this author , Ryan MooneyRyan Mooney More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Billy CordonBilly Cordon More articles by this author , Matthias HoferMatthias Hofer More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.837AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Synchronous ipsilateral placement of artificial urinary sphincter (AUS) pressure regulating balloons (PRB) and inflatable penile prosthesis (IPP) reservoirs in a single submuscular tunnel is a novel strategy which may be advantageous for prosthetic urology patients who have had previous major pelvic surgery. We report our initial experience with ipsilateral versus bilateral placement of the AUS PRBs and IPP reservoirs in men having synchronous implant surgery. METHODS We retrospectively reviewed all patients having synchronous AUS and IPP placement from 2007-2015 by the senior author at our tertiary center. Patients were grouped according to the whether they had ipsilateral versus contralateral placement of the AUS PRB and IPP reservoir. Among the 47 patients who underwent synchronous AUS/IPP implantation during the study period, we compared the reoperation rates due to infectious/erosive complications or mechanical failure in each group. The Fisher's exact test was used for all comparisons. RESULTS Among the 968 men who underwent implant surgery during the study period, we identified 47 who having synchronous device placement, 17 of whom (36%) underwent ipsilateral placement of the PRB/reservoir. With a median follow up of 24 months (range 3-73 months), reoperations were necessary in 12/47 (26%) and were similar between groups (ipsilateral: 5/17, 29%; bilateral: 7/30, 23%; p=0.73). Indications for reoperation included mechanical device failure in 5/47 (ipsilateral: 1/17, 6%; bilateral: 4/30, 13%; p=0.56) devices, cuff erosion in 4/47 (ipsilateral: 1/17, 6%; bilateral: 3/30, 10%; p=0.99), and infections in 3/47 (ipsilateral: 2/17, 12%; bilateral: 1/30, 3.3%; p=0.54). Nearly all reoperation patients (11/12, 92%) had compromised urethras, defined by prior implant or urethral surgery (7/12, 58%) or radiation (4/12, 33%). CONCLUSIONS Synchronous ipsilateral high submuscular placement of urologic prosthetic balloons and reservoirs can be done without an increase in infectious/erosive complications or device failure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e791-e792 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nicholas Kavoussi More articles by this author Ryan Mooney More articles by this author Jeremy Scott More articles by this author Billy Cordon More articles by this author Matthias Hofer More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Augmented reality assisted surgery: a urologic training tool.

Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass® optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a 10-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.

Case Report: Delayed presentation of penile epidermoid cyst following reconstruction for Peyronie's disease.

Penile masses are a concerning finding for both patient and clinician upon initial presentation. There is a wide differential for penile masses from the benign (fibrous plaques, cysts, ulcerative lesions, benign penile pearly papules, etc.) to more concerning malignant lesions. A proper history and physical is the first step to determining the etiology of the mass and any future clinical interventions. In this paper, we review a case of a 73-year-old male who is found to have an enlarging mass during work-up for possible placement of inflatable penile prosthesis. Fortunately, the mass was determined to be a benign epidermoid cyst presenting thirty years after reconstruction for Peyronie's disease using dermal penile skin graft. With this unique presentation we review the scant literature on penile mass formation following Peyronie's repair.

Minimizing Penile Implant Infection: A Literature Review of Patient and Surgical Factors.

Inflatable penile prosthesis (IPP) is an effective treatment for erectile dysfunction in patients' refractory to oral or injectable treatment. While the rate of infection has decreased over the past decade, it is still the most feared complication of IPP placement. Here, we assemble possible patient and surgical factors attributing to the risk of infection. Studies have been gathered addressing each of these factors, and an Oxford Level of Evidence is assigned to each recommendation based on strength of the study. The goal of this review is to inform surgeons of possible risks in order to further reduce the risk of infection and thus increase success of IPP placement.

Intraoperative Decision-making for Precise Penile Straightening During Inflatable Penile Prosthesis Surgery

To present a novel algorithm for definitive reconstruction of penile curvature in men undergoing inflatable penile prosthesis (IPP) surgery as an alternative to manual penile modeling and grafting procedures. Patients with erectile dysfunction and concomitant penile curvature undergoing IPP placement were divided into 2 treatment groups: (1) group 1, penile deformity known preoperatively, and (2) group 2, penile curvature recognized intraoperatively after IPP placement. Group 1 patients underwent penile plication after artificial erection and immediately before IPP insertion via the same penoscrotal incision, whereas group 2 patients were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. Patients completed postoperative Patient Global Impression of Improvement (PGI-I) questionnaires assessing overall satisfaction. Among 405 men receiving IPP at our institution from 2007 to 2014, 30 patients received synchronous correction of penile curvature (7%). Group 1 included 23 of 30 (77%) patients, and 7 of 30 (23%) were in group 2. Overall mean initial curvature was 36°, and all patients were corrected to < 10°. Average operative times were 18 minutes longer compared with patients who underwent IPP placement alone (82 vs 64 minutes, P <.05). At an average follow-up of 13 months (range 7-32), 19 of 20 (95%) group 1 and 6 of 7 (86%) group 2 patients who completed surveys reported an improved overall condition. No patient reported chronic pain, recurrent deformity, or device malfunction. Penile curvature can be safely and reliably corrected at the time of IPP placement, regardless of whether the deformity was identified preoperatively.

Bone Saw for Calcified Peyronie's Disease Plaques

To determine the incidence of calcified Peyronie's disease plaque that cannot be cut with a blade in a 100-case series and to describe the use of a soft tissue-protecting bone saw for plaque incision. Chart reviews were done of all surgically treated Peyronie's disease patients at our center between October 1996 and December 2012. 100 cases were included. We evaluated our novel technique of tissue-protecting bone saw surgical use. 100 consecutive patients underwent surgery for Peyronie's disease, and 6 required transverse bone saw plaque incision due to the severity of calcification that could not be cut with a blade. Four of those 6 underwent grafting procedures with porcine submucosal intestinal substance (SIS) and 2 underwent placement of inflatable penile prosthesis (IPP) after plaque incision. There were no surgical complications. Both IPP patients had functioning prosthesis 4 and 7.3 years after surgery. One SIS-graft patient required re-operation for more proximal curvature 11 months later and ultimately required multiple plaque incisions and an IPP. Densely calcified plaques occurred in 6% of a surgical series of Peyronie's disease patients. The vibrating bone saw is a novel technique to incise calcified plaques before grafting or IPP placement.

Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference.

Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie’s disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

Examining Postoperative Outcomes after Employing a Surgical Algorithm for Management of Peyronie's Disease: A Single-Institution Retrospective Review.

Surgery remains the gold standard treatment for men with stable Peyronie's disease (PD). In an attempt to guide operative selection, we report our series of penile-straightening procedures for PD, using a surgical algorithm that recommended tunica albuginea plication (TAP), partial plaque excision and grafting (PEG) or inflatable penile prosthesis (IPP) placement. With this study, we attempt to further refine surgical approach, define realistic surgical outcomes, and help establish reasonable postoperative expectations for treatment of PD. We retrospectively reviewed all patients who underwent surgery for PD at our institution between 2007 and 2013. Work-up involved a history, physical exam, and a duplex ultrasound. Several questionnaires were employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed postoperatively. Primary outcomes include postoperative patient satisfaction with rigidity, curvature, and ability to engage in intercourse. Secondary outcomes include comparing emotional, relationship, and psychological distress to severity of disease. A total of 390 patients underwent penile-straightening procedures for correction of PD. Of these patients, 29%, (n = 114) underwent TAP, 41% (n = 159) PEG, and 30% (N = 114) IPP. Mean follow-up was 17 months. The three surgical modalities showed no significant difference in satisfaction with penile rigidity, presence of bothersome residual curve, or ability to engage in intercourse. Preoperatively, 80% of men reported a negative effect of PD on their emotional status. Postoperatively, 88.4% of men were able to engage in penetrative intercourse, while only 70% were satisfied with rigidity and 84.9% were satisfied with curvature correction. Patient experience with postsurgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups, supporting the use of this surgical algorithm. The majority of patients with PD experience some degree of emotional and psychological distress, which may compromise patient satisfaction.

PEYRONIE'S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT.

Peyronie's Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical exam, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and work-up for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase Clostridium hystiolyticum have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.