Simultaneous ventral tunical grafting and three pieces inflatable penile prosthesis implantation

VJPU 2016; 2: 075

Giulio Garaffa1, Marco Capece2, Giovanni Chiriaco3, Giovanni Liguori3, Carlo Trombetta3, David J Ralph1

1: The Institute of Urology, UCLH, England
2: University of Napoli, Italy
3: University of Trieste, Italy

Keywords: Peyronie’s Disease, graft, penile prosthesis

Introduction: Surgeons can rely on a variety of manoeuvres to ensure that the penis is straight enough following penile prosthesis implantation in patients with Peyronie’s Disease (PD).

Case presentationThis is the case of a 65 year-old patient with end stage erectile dysfunction and a 90 degrees ventral curvature secondary to PD who has undergone implantation of a three pieces inflatable penile prosthesis. Since the modelling manoeuver is contraindicated in patients with ventral curvature, adequate straightening has been obtained with plaque incision and grafting.

Protocol: Once the penile shaft has been degloved through a subcoronal incision, the urethra is dissected off the corpora cavernosa through two para-urethral incisions of buck fascia. A double Y relaxing incision of the tunica albuginea is then performed at the point of maximum curvature to guarantee adequate straightening and the resulting defect is grafted with porcine intestine (Biodesign®- Cook). A three pieces inflatable penile prosthesis is then inserted though the same approach and a 125 cc reservoir has been placed ectopically.

Outcome: Postoperative time has been uneventful. Six months postoperatively the patient is able to engage in penetrative sexual intercourse and is fully satisfied with the outcome of surgery.

Discussion: The aim of penile prosthesis implantation in PD is to guarantee a penis rigid and straight enough for penetrative sex. The modelling manoeuver is extremely effective in the correction of residual curvature, but it is contraindicated in patients with ventral curvature due to the risk of urethral rupture. Ventral curvatures therefore need to be addressed with tunical incision +/- grafting of the concave aspect or with plication of the convex one. When degloving is indicated, the penile prosthesis can be inserted though the same incision, obviating the need for a second penoscrotal approach.