Wednesday, 26 October 2016

Penile shortening due to Peyronie's Disease: a solution is possible?

Peyronie's Disease is associated with the formation of anelastic scars on the tunica albuginea of the penis. As the scar does not stretch as the surrounding tunical tissue, during erections it can cause deformity and a degree of penile shortening. A degree of erectile dysfunction is also a common finding in patients with Peyronie's Disease.
Classically, patients with Peyronie's Disease and refractory erectile dysfunction are managed with penile prosthesis implantation in order to obtain the straightening and the rigidity necessary to engage in penetrative sexual intercourse.
Although successful in correcting the deformity and the erectile dysfunction, penile prosthesis implantation alone is not able to restore the length lost due to Peyronie's Disease, and this is why postoperative satisfaction rates in this subgroup of patients is not as high as in the other subgroups of implant patients, where no preoperative loss of length is present.
In order to address the loss of length, a very selective group of patients with Peyronie's Disease and severe shortening can now be offered penile length and girth restoration in combination with penile prosthesis implantation. This is a very complex procedure that should be performed only by high volume experienced implant surgeons. Once the penis is disassembled into the urethra, the neurovascular bundle and the corpora cavernosa, the length and girth are restored by incising circumferentially the tunica albuginea and filling the defect with a graft. In experienced hands, results can be very encouraging, with an average gain of 3.5 cm in length.
Complication rates following this procedure is however higher that after penile prosthesis implantation alone and should therefore be offered only to carefully selected and highly motivated patients.

Further reading:
  • Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, Falcone M, Fontana D. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012 Sep;9(9):2389-95. doi: 10.1111/ 1743-6109.2012.02675.x. Epub 2012 Mar 16. PubMed PMID: 22429331.
  • Rolle L, Falcone M, Ceruti C, Timpano M, Sedigh O, Ralph DJ, Kuehhas F, Oderda M, Preto M, Sibona M, Gillo A, Garaffa G, Gontero P, Frea B. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the ‘sliding’ technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016 May;117(5):814-20. doi: 10.1111/bju.13371. Epub 2015 Dec 21. PubMed PMID 26688436.

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