Penile Deformity Research Articles

The Surgical Treatment of Peyronie’s Disease in the Older Man: Patient Characteristics and Surgical Outcomes in Men 65 and Older

IntroductionSurgery remains the gold standard for the correction of penile deformities secondary to Peyronie’s disease (PD). Nevertheless, there is no published data on the surgical treatment of PD in older men. AimConsidering the aging national and international population, we sought to evaluate the pre-operative characteristics and surgical outcomes of men aged 65 or older who underwent surgical treatment for PD at our tertiary care institution. MethodsWe retrospectively reviewed the charts of all men 65 years or older who underwent surgery for PD from January 2010 to September 2017. We compared men who underwent penile prosthesis implantation with straightening maneuvers (PP+SMs), tunica albuginea plication (TAP), and plaque partial excision with grafting (PEG). Main Outcome MeasureThe main objective of this study was to find the baseline pre-operative patient characteristics and postoperative patient-reported outcomes. ResultsA total of 86 men with a median age of 68 years underwent surgery during the study period. 39 men underwent PP+SM (45%), 25 men a TAP (29%), and 22 men a PEG (26%). The mean curvature for all men was 59.9 ± 22.0° (range 0−105°). Those who underwent a PEG had a mean ± SD degree of curvature of 78.6 ± 16.6°, significantly higher than those who underwent PP+SM or TAP (49.1 ± 20.2° and 61.4 ± 17.4°, respectively; P < .001). Moreover, men who underwent a PEG had significantly more complex penile deformities (eg, narrowing with hinge effect) and better reported baseline erectile function compared with men who underwent PP+SM or TAP. Overall, 95% of all men reported having a functionally straight penis postoperatively with 94% engaging in penetrative intercourse at last follow-up. Overall, patient-reported satisfaction was 85% with a median follow-up of 43.5 months. Clinical ImplicationsOur findings suggest that the surgical treatment of PD in older men is safe, effective, and associated with high patient satisfaction. Although this represents a surgical series susceptible to selection bias, it underscores the importance of patient selection and counseling in achieving good surgical outcomes. Strengths & LimitationsOur study is the first to report on outcomes of surgical treatment of PD in an elderly patient population with relatively long-term follow-up. Our limitations include a small sample size, single operating surgeon, and the lack of a younger comparison group. ConclusionDespite an aging global population, surgery remains a viable and reliable option for the properly selected and counseled older men with PD.Abdelsayed GA, Setia SA, Levine LA. The Surgical Treatment of Peyronie’s Disease in the Older Man: Patient Characteristics and Surgical Outcomes in Men 65 and Older. J Sex Med 2019;16:1820–1826.

Modern treatment strategies for penile prosthetics in Peyronie's disease: a contemporary clinical review.

Peyronie's disease is a common condition resulting in penile deformity, psychological bother, and sexual dysfunction. Erectile dysfunction is one common comorbid condition seen in men with Peyronie's disease, and its presence significantly impacts treatment considerations. In a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. In some instances, such as those patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling, penile plication, and tunica albuginea incision with or without grafting. For patients with severe penile shortening, penile length restoration techniques may also be considered. Herein, we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's disease. Specifically, we discuss preoperative indications, intraoperative considerations, adjunctive straightening maneuvers, and postoperative outcomes.

Manual modeling for the correction of residual curvature in Peyronie’s disease

Peyronie’s disease (PD) is postulated to be a disorder of penile wound healing, resulting in fibrosis of the tunica albuginea and plaque formation. It can lead to penile deformity, discomfort, and curvature prohibiting sexual intercourse. The disease has two phases.

Фаллопротезирование через завенечный доступ c безграфтинговой корпоропластикой при эректильной дисфункции, сочетанной с болезнью Пейрони

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.

The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study.

BackgroundAnatomic and functional evaluation of the penis before treatment is very important in the choice of treatment in patients with Peyronie’s disease (PD).AimTo compare 3 different methods for the evaluation of the penile deformity, including auto-photography, combined intracavernous injection stimulation test (CIS), and 3-dimensional computed tomography (3D CT) during artificial penile erection in patients with PD.MethodsPretreatment penile deformities of patients with PD were compared with those detected with auto-photography, using goniometer after intracavernosal vasoactive agent, and 3D CT correlations among these 3 methods were investigated.Main Outcome MeasuresAssessments of penile curvature with auto-photography, CIS, and 3D CT.ResultsThe mean age of 36 patients who were included in the study was 58 ± 8.25 (36–72) years, and the mean time since the onset of the disease was 25 ± 24 months (2–144). Degrees of penile curvatures measured using auto-photography, CIS, and CT were determined as 24° (0°–80°), 40° (0°–90°), and 34° (0°–80°), respectively. When general correlation analysis was performed to evaluate the penile curvatures of all patients using 3 methods, a moderate correlation between auto-photography and both CIS (r = 0.72, P < .001) and 3D CT (r = 0.56, P < .001) was detected, whereas a strong correlation was noticed between CIS and 3D CT (r = 0.78, P < .001). When the correlation analysis between patients with and without ED was examined, a statistically significant decrease in the strength of correlation between CIS and auto-photography in patients with ED (0.629 vs 0.925, P < .05), however, was detected without any statistically significant difference in patients without ED (0.694 vs 0.813, P > .05).ConclusionThe superiority of 3D CT over auto-photography and its strong correlation with CIS in most parameters have been demonstrated. However, it was found that CT did not give more information than the evaluation with CIS. Current limitations and cost increases limit the use of 3D CT in the assessment of PD.Özmez A, Ortac M, Cevik G, et al. The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study. Sex Med 2019;7:311–317.

Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease

IntroductionThere are some data suggesting that there is a relationship between the magnitude of Peyronie’s disease (PD)–associated penile curvature and low serum testosterone. AimTo evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels. MethodsWe identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection–induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T: <300 ng/dL; normal T: ≥300 ng/dL). Second, an association was sought between T levels based on quartiles of the normal range (<300, 300–450, 450–600, and >600 ng/dL). These analyses were conducted for both TT and FT levels and using both raw and standardized T values. Third, multivariable analysis using multiple linear regression was performed in an attempt to define predictors of the degree of penile curvature. Factors entered into the model included: TT level, FT level, patient age, race (white vs other), number of co-morbidities, body mass index, presence of erectile dysfunction, duration of PD, and prostatectomy (yes vs no). Main Outcome MeasuresThe relationship between T levels and the magnitude of penile curvature. Results184 subjects met all study criteria. Average age was 54 ± 12 years. Mean TT level was 425 ± 176 ng/dL, and mean curvature magnitude was 35° ± 19°. The percent of subjects in the first through fourth TT quartiles was 26%, 34%, 24%, and 16%. As a continuous variable, there was no association between TT levels (r = −0.01, P = .95) or FT levels (r = −0.08, P = .30) and the curvature magnitude. When examining TT groups, there was no difference in mean curvature between the low TT group and the normal TT group (35.4° ± 17° vs 34° ± 20°, P = .70). When analyzing the TT and FT levels standardized into z-scores, there was no association between degree of curvature and TT z-scores (r = −0.003, P = .95) and FT z-scores (r = −0.08, P = .43). There was also no association between testosterone levels and degree of curvature in the multivariable model. ConclusionsThere does not appear to be any association between testosterone levels and the magnitude of PD-associated penile deformity.Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease. J Sex Med 2019;16:1283–1289.

A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease.

Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.

Penile Fracture : Experience from a Tertiary Care Hospital

Introduction: Penile fracture is a misnomer, penile fracture is defined as rupture of the tunica albuginea of one or both corpus cavernosum. The usual cause is abrupt bending of the erect penis by blunt trauma, which may occur during sexual intercourse, masturbation, rolling over on the bed, or falling onto the erect penis. Diagnosis of penile fracture is made on the basis of history and physical examination. the standard model of management is surgical.Methods: This retrospective study was conducted in the department of surgery SMHS hospital Srinagar,(Jammu and Kashmir), extending over a period of about three and a half years from June 2013 to January 2017. All patients with diagnosed penile fracture were included in this study. All except one patient were operated on the same day of admission.Results: out of a total of 50 patients studied, the mean age of presentation was 26.7 years. The majority (56%)were below 30 years of age.21 (42%) of the patients were married.majority42% of the patients reported masturbation as a cause of trauma, followed by vaginal intercourse in38% and rolling on the erect penis in 20%. About 80% of patients gave a history of audible click/crackling sound. All patients had swelling and discoloration on examination,90% of patients had a penile deformity, only 36 % had a palpable defect. Doppler USG was correct in 93% of patients. The majority (44%) of patients had defects less than 1cm. the defect was mostly seen on the right side (68%).most patients had proximal penile defect (56%). Mean hospital stay was 2.9 days. One patient (2%) had urethral trauma.Surgery had a recurrence of 2%.and a total postoperative complication rate of 10%.Conclusions: Penile fracture though reported rarely, is a common entity. Penile fracture is a urological emergency.Diagnosis is mainly on clinical grounds.Immediate surgical repair is the standard treatment of a penile fracture.

Clinical characteristics and surgical outcomes in men undergoing tunica albuginea plication for congenital penile curvature who present with worsening penile deformity.

Men with congenital penile curvature (CPC) can develop new onset worsening of their lifelong curvature. We sought to evaluate clinical characteristics and postoperative outcomes after tunica albuginea plication (TAP) in patients presenting with CPC who reported new onset worsened curvature (CPC-WC), and compare these with patients reporting stable lifelong curve ("CPC-only"). A retrospective review of demographics, history/exam findings, and postoperative outcomes for patients with CPC who underwent TAP from 2012 to 2018 was performed. Patients were differentiated based on whether or not they reported new onset worsening of their penile curvature preoperatively (CPC-WC versus CPC only). Statistical analysis was performed to identify differences in clinical characteristics and postoperative outcomes after TAP. 60 patients were included [CPC only (n = 39) and CPC-WC (n = 21)]. Mean curvature was 62° (SD 23). CPC-WC patients were older [median 34years (IQR 27:52) versus 24years (IQR 20:34); p = 0.004], and more likely to report penile shortening and psychological bother (p < 0.05). On physical examination, CPC-WCs were more likely to have a discrete palpable tunical scar and diminished penile elasticity (p ≤ 0.0002). With median follow up of 12 months, satisfactory straightening with TAP was reported in 56/60 patients (93%) including 35/39 (90%) CPC only and 21/21 (100%) CPC-WC. In men undergoing TAP for CPC, we found that 35% reported new onset worsening of their original curvature preoperatively. These patients were older and more likely to report penile shortening or exhibit palpable tunical scarring with decreased elasticity on examination compared to those with lifelong stable curvature. Regardless, TAP resulted in satisfactory penile straightening in the majority of patients.

HP-06-003 Sexual desire assessment in patients with Induratio Penis Plastica (IPP) and Recurvatum penis treated with surgical correction

Sexual desire isn’t usually assessed during consultation for IPP; We have attempted to measure the libido in patients treated with corporoplasty for penile deformity. 15patients,aged53-72years(m.62,3years),with IPP and severe penile deformity underwent surgical procedure. Before surgery photography of erected-penis were taken and sexual desire was measured with our questionnaire. We administered the questionnaire before procedure and12weeks after.All patients used before surgery PDE5i, so 12week after we administered themIIEF5. Recurvatum was moderate/marked(>60°) with slight/moderate, hourglass-deformity . We carried out 12albuginea plications with urethral and dorsal bundle dissection and with dissection of the deep layer of the plaque respecting its superficial layer. 3 patients had dissection of the plaque with goretex patch. The plasmatic total testosterone(TT) before surgery was350to610ng/dl(m.464,7+/-80), 12weeks after, TT was320to550ng/dl(m.457+/-65),without significant differences. The libido was between 7(normal) and15(mildly reduced)(m.11+/-2,5), 3months after, it was between 6(normal)to13(slight reduction)(m.8,6 +/-1,6), with significant improvement. The IIEF5 after12weeks of surgery, was between 17and25. The correction of recurvatum was good in all cases and the patients was satisfied.

PD43-05 EXTERNAL VALIDATION OF A PRIAPISM QUESTIONNAIRE IN A JAMAICAN COHORT OF SICKLE CELL DISEASE PATIENTS

INTRODUCTION AND OBJECTIVES:Little is known about the long-term consequences of recurrent priapism on erectile function, penile deformity, and mental health. The Priapism Impact Profile (PIP) is a ...

168 Peyronie’s Disease: Can We Standardize Utrasonographic Descriptors?

Evaluation of Peyronie’s disease (PyD) utilizing penile Color Doppler Duplex Ultrasound (CDDU) provides insight on disease characteristics, severity of concomitant erectile dysfunction, and anatomical variations in disease presentation. The literature provides limited guidance regarding the ultrasonographic appearance of Peyronie’s plaques. Published guidelines suggest successful triage of PyD patients should be based upon evaluation of both penile deformity and the presence or absence of vascular ED. The purpose of this study is to establish a functional and reproducible anatomical classification system for Peyronie’s disease based on a large retrospective series in which a single examiner utilized penile CDDU to evaluate variations in plaque appearance and ultrasonographic characteristics. During work-up for Peyronie’s disease, 571 patients were examined using penile CDDU performed by a single surgeon at our institution between February 2005 to March 2018. Images and disease characteristics were recorded at the time of CDDU evaluation and Doppler 2D images were reviewed by an independent examiner based on classification criteria as follows: Grade I- hypoechoic shadowing without calcification; Grade II- focal microcalcifications; Grade III- scattered microcalcifications; Grade IV- confluent calcified and palpable plaque (a) of the tunica albuginea or (b) of the septum.

172 Effect of Race on Treatment Choice and Outcomes for Peyronie's Disease

Peyronie’s disease (PD) is a debilitating progressive fibrotic disorder of the penis that can lead to significant pain, erectile dysfunction, and emotional distress. Traditionally considered a disease of middle-aged Caucasian men, PD is now seen in a wider demographic of patients seeking evaluation and treatment. This trend may be attributable to increased awareness of the condition. Within this more diverse patient population, PD treatment and outcome satisfaction can be highly patient specific and may be dependent on multiple factors. We sought to evaluate the influence of patient race on treatment choice and outcomes among a contemporary cohort of men with PD. We conducted a retrospective chart review of all 18-70 year old men presenting to our academic medical center between 1/1/2012 to 12/31/2016 for evaluation and treatment of PD. Information on age, race, medical comorbidities, severity of penile deformity, treatment choice(s), and treatment outcomes was abstracted from the electronic medical record. Severity of penile deformity was based on objective curvature assessment at time of penile Doppler ultrasound (PDUS). Only patients who completed treatment(s) for PD at our institution were included in the final analysis of treatment outcomes and treatment satisfaction.

PENILE FRACTURE : EXPERIENCE FROM A TERTIARY CARE HOSPITAL

Introduction: Penile fracture is a misnomer,penile fracture is defined as rupture of the tunica albuginea of one or both corpus cavernosum. The usual cause is abrupt bending of the erect penis by blunt trauma, which may occur during sexual intercourse, masturbation, rolling over on the bed or falling onto the erect penis. Diagnosis of penile fracture is made on the basis of history and physical examination.standard mode of management is surgical. Methods: This retrospective study was conducted in the department of surgery SMHS hospital srinagar ,(Jammu and Kashmir), extending over a period of about three and a half years from june 2013 to January 2017 . All patients with diagnosed penile fracture were included in this study. All except one patient were operated one the same day of admission. Results: out of a total of 50 patients studied ,the mean age of presentation was 26.7 years.Majority ( 56% )were below 30 years of age.21 ( 42% ) of the patients were married.majority 42% of the patients reported masturbation as cause of trauma,followed by vaginal intercourse in 38% and rolling on erect penis in 20% .About 80% patients gave history of audible click/crackling sound.All patients had swelling and discolouration on examination, 90% patients had penile deformity,only 36 % had palpable defect.Dopler USG was correct in 93% patients.Majority ( 44% ) patients had defect less than 1cm.defect was mostly seen on right side ( 68% ).most patients had proximal penile defect ( 56% ). Mean hospital stay was 2.9 days. One patient ( 2% ) had urethral trauma.Surgery had a recurrence of 2% .and a total postoperative complication rate of 10% . Conclusions: Penile fracture though reported rarely, is a common entity. Penile fracture is a urological emergency.Diagnosis is mainly on clinical grounds.Immediate surgical repair is the standard treatment of penile fracture.

Is Degloving the Best Method to Approach the Penile Corporoplasty With Yachia's Technique?

To assess functional outcomes after surgical correction of congenital and acquired penile curvatures using Yachia's technique (YT) with degloving (DG) and without degloving (WDG) of the penis. A penile deformity with angle ≥30°, difficulty in vaginal penetration, and severity of erectile dysfunction secondary to penile curvatures were the indications for a surgical treatment with YT. The preoperative characteristics of the patients, postoperative outcomes (change in angulation, palpation of sutures, penile shortening, and patient satisfaction), operative time, and hospital stay were recorded. A total of 64 patients were included in this review and divided into 2 groups: 34 in group I (YT with DG) and 30 in group II (YT-WDG). The mean operative time was 65.87 ± 21.32 minutes for group I and 48.17 ± 23.82 minutes for group II (P < .02). The mean hospital stay was 3.09 ± 0.96 and 2.87 ± 0.93 days in DG and WDG, respectively (P = .324). There were no significant differences in recurrence rates and complications (palpation of sutures: group I: 14.7% vs. group II: 13.3%; penile shortening: group I: 8.9% vs. group II: 10%). At follow-up of 20.8 months, all treated patients were able to insert the penis in the partner's vagina, were satisfied overall with sexual intercourse. The outcomes of the DG and WDG techniques were similar, even if the YT-WDG presents better results in terms of less healing and operative time.

Erectile dysfunction after urethroplasty.

IntroductionThe aim of this study was to analyze the influence of urethroplasty on sexual function.Material and methodsWe analyzed 75 operations: 41 anastomotic, 13 labial graft, 6 thigh skin mesh graft, and 15 penile skin flap urethroplasties. The severity of erectile dysfunction was assessed in the International Index of Erectile Function (IIEF5) questionnaire, preoperatively and at least 3 months after the surgery. The appearance of possible penile deformities was also evaluated postoperatively.ResultsThe etiology and location of the stricture had no impact on the erectile dysfunction in men with untreated urethral stricture. The difference in mean IIEF5 score before and after the first urethroplasty was not statistically significant (12.58 ±9.01 and 10.88 ±9.28; t(42) = 1.25, p = 0.220). The length of the stricture had no impact on the preoperative and postoperative IIEF5 score. Stricture in penile urethra caused a risk of postoperative penile curvature (p = 0.023).ConclusionsPatients with urethral stricture have a higher rate of erectile dysfunction than healthy men. Proper therapy should not negatively affect erectile function in a significant way, regardless of the length or location of the stricture, though it may have some influence on the penile anatomy.

Non-invasive treatment in the management of Peyronie's disease.

Peyronies disease (PD) is estimated to affect approximately 3–9% of men worldwide and maybe associated with pain, erectile dysfunction and penile deformity including shortening. The condition has significant debilitating effects on quality of life, self-esteem and psychological wellbeing in addition to sexual function. Surgical results add further to this by patients having dissatisfaction with various aspects of outcomes. Non-surgical management may allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. Several non-surgical options are currently being employed in the treatment of PD that may reduce or stabilize both objective measures (e.g. penile length and deformity) and subjective measures (including sexual function, pain and partner satisfaction). Nonsurgical management can allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. In this article we explore the current non-surgical management options for PD including oral, mechanical therapies, intralesional and topical treatments. We also briefly discuss future treatment options in the form of stem cell therapy.

Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease.

IntroductionSurgery remains the gold standard for treatment in stable patients with penile deformity associated to Peyronie’s disease (PD).AimTo evaluate the long-term results of plaque incision and buccal mucosa grafting (BMG), with or without additional tunica albuginea plication (TAP), in the correction of severe penile curvatures secondary to PD.Methods72 patients with severe curvature caused by PD, normal erections, and stable disease entered this prospective study. Preoperatively, they underwent penile duplex ultrasounds with measurement of curvature and length of affected side. All procedures were carried out by 1 surgeon. Patients were seen at 1, 3, 6, and 12 months postoperatively, then yearly. Subjective outcome was assessed by the Sexual Encounter Profile (SEP) questionnaire, and objective outcome was assessed by an intracavernous injection (ICI) test performed within the first year for evaluating penile rigidity, straightness, and length.Main Outcome MeasureLong-term outcomes include penile straightening, penile shortening, and sexual satisfaction.ResultsMean curvature was 71.32 ± 17.6° (range 40–110); 33 (45.8%) patients had a 2-sided curvature with a mean second curvature of 33.79 ± 12.2° (range 10–60). Additional TAP was needed in 60% of patients for complete straightening or graft stretching. All patients resumed unassisted intercourse 1 month after surgery; 4 (5.5%) refused follow-up, claiming excessive penile shortening. In the remaining 68, the ICI test showed no recurvature, shortening, or de novo erectile dysfunction. At mean follow-up of 62.01 ± 34.3 months (range 12–135), all were able to obtain an erection (SEP-1), 97.1% to penetrate (SEP-2), and 89.7% to successfully complete intercourse (SEP-3); 80.9% of them were satisfied with erection hardness (SEP-4) and 86.8% were overall satisfied (SEP-5), with the main reason for dissatisfaction being expectation of better length and rigidity.ConclusionBMG, with or without TAP, provides excellent long-term results and is safe and reproducible, representing a valuable treatment option for PD, but great care should be taken in patient counseling to avoid unrealistic expectations.Cormio L, Mancini V, Massenio P. Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie’s Disease. Sex Med 2019;7:48–53.

Complications of Genital Enlargement Surgery

IntroductionThe objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients. AimWe aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management. MethodsInstitutional review board approval was obtained. We reviewed our prospectively collected database for all patients who presented with complications of genital enlargement surgery from 2002–2016. Main Outcome MeasureInterventions following complications of genital enlargement surgery. Results11 Patients were identified. Mean age was 47 (21–77) years. Prior procedures included subcutaneous injection of silicone outside a medical setting, girth enhancement procedures involving the subcutaneous placement or injection of substances including fat, other substances, or subcutaneous silicone implants. All patients who underwent subcutaneous penile implant underwent removal prior to presentation. Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction. 10 patients underwent corrective surgery, with 2 requiring multiple procedures and 3 requiring split-thickness skin grafting. All 10 patients had an improved cosmetic appearance and those who had disabling shortening had significantly improved functional length. Clinical ImplicationsReport of such adverse events should assist in appropriate perioperative counseling prior to genital enhancement surgery. Strength & LimitationsFew reports of debilitating complications of penile enlargement exist in literature. However, without knowing the overall number of procedures performed, the true complication incidence is not known. ConclusionPenile and scrotal enhancement surgery can be associated with major disabling complications, leading to deformity and functional compromise in men with prior normal anatomy and function. Patients should be aware of these risks.Furr J, Hebert K, Wisenbaugh E, et al. Complications of Genital Enlargement Surgery. J Sex Med 2018;15:1811–1817.

48] The role of penile rehabilitation for Peyronie’s disease, does it really work?

ObjectiveTo assess the role of penile rehabilitation for Peyronie’s disease (PD). PD causes penile deformity and erectile dysfunction (ED) in sexually active men with an incidence of 3–9%. Penile rehabilitation is recommended (European Association of Urology 2016) to limit the progression of the disease.