“Punch Technique” for Trans-Corporal Excavation of Peyronie’s Plaques upon Penile Prosthesis Implantation

Authors: Prof.Osama Shaeer

Key words: Peyronie’s disease, plaque excision, scratch technique, penile curvature, penile prosthesis, penile implant

1. Introduction
Cases with severe erectile dysfunction and severe Peyronie’s deformity may require penile prosthesis implantation along with plaque surgery. The latter requires considerable additional operative time and adds to the possibility of infection. The Punch Technique is a minimally invasive procedure for plaque de-bulking from within the corpora cavernosa, with low or no risk of urethral or nerve injury.

2. Case presentation
The procedure was performed for 26 patients with severe refractory erectile dysfunction and severe Peyronie’s deformity

3. Protocol
Following corporotomy and dilatation, Peyronie’s plaques were punched-out using the punch forceps. The punch forceps is a reusable metal instrument widely used to cut-out vertebral bony protrusions in neurosurgery. After Peyronie’s plaques were cleared out, penile prosthesis implantation proceeded as usual.

4. Outcome
Prior to excavation, deviation was evaluated in artificial erection and ranged from 40-80 degrees, average 68  2. Direction of curvature was dorsal in 11 patients, dorsolateral in 7 and ventral / ventrolateral in 8.
Following the Punch technique, all patients were clear of Peyronie’s plaques as per palpation. Upon evaluation of deformity with the implant in the erect state, all patients had a straight penis. No adjuvant measures were required. Average additional operative time for Punch technique ranged from 5 to 10 minutes.

Twenty-five implants survived adequately, with no residual or recurrent curvature. No urethral complications or extrusions were noted. Penile sensitivity was preserved as per subjective reports. Satisfaction with length on a five-point scale (1 being lowest satisfaction and 5 being highest) revealed an average score of 4.2  3, range 3 to 5. One out of 26 patients suffered penile prosthesis infection. Implant was extracted with subsequent delayed re-implantation.

5. Discussion
The “Punch Technique” allows safe and expedited excavation of Peyronie’s plaques upon penile prosthesis implantation, obviating the need for mobilization of the neurovascular bundle or the spongiosum, and obviating the need for plaque excision and grafting.

Disclosures:The authors have nothing to disclose.

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