A significant number of patients with both Peyronie’s Disease and Erectile Dysfunction will ultimately undergo penile prosthesis placement. A number of options exist for the management of penile curvature at the time of prosthesis insertion. If the curvature is less than 30 degrees, typically the insertion of a penile implant possibly combined with penile modeling will correct the curvature. In patients with penile curvature greater than 30 degrees, penile modeling is not as effective and may take up to one year to see any results. I will describe a very simple technique, which is reproducible, and will correct the curvature. Below is the abstract from the Video Journal of Prosthetic Urology (VJPU 2016; 2: 056).
Inflatable Penile Prosthesis Placement for Erectile Dysfunction in conjunction with Plication for Peyronie’s Disease
Penile plication at the time of penile prosthesis insertion can provide immediate straightening. This approach is utilized for peyronie’s patients with penile curvature between 30 and 60 degrees.
Case Presentation: The patient had coexisting erectile dysfunction and significant curvature from his peyronies disease.
Protocol: A transverse scrotal incision is used, providing excellent exposure. An 8 dot technique is used for the plication suture placement. The plication sutures (2-0 fiber wire) are placed prior to insertion of the penile prosthesis. Once the device is inserted and inflated the sutures are tensioned correcting the curvature. The device is left partially inflated at the conclusion of the procedure and a closed suction drain is utilized. The Henry Mummy wrap is used at the end of the procedure.
Discussion: The benefit of this simplified approach is immediate straightening of the penile curvature at the time of penile prosthesis insertion, whereas penile modeling may take several months of usage to achieve the same excellent result. Also contrary to penile modeling there is no risk of urethral injury.