Title: Peyronie’s Disease and Erectile Dysfunction: IPP and Modeling
Author: Tapscott, Ashley H
Key Words: Peyronie’s Disease, Penile Modeling, Wilson Modeling Maneuver, Erectile Dysfunction, Penile Prosthesis, Penile Implant
This video demonstrates the technique of surgical correction of both Peyronie’s Disease and erectile dysfunction in a patient. The indications for surgical reconstruction are discussed. Our video describes all steps of the surgery, as well as special attention to portions that may encounter difficulty in a Peyronie’s patient This includes a step by step video sequence describing a manual modeling, possible complications and their management.
A transurethral catheter is placed prior to surgery. An artificial erection is initiated by infusion of saline after placing a tourniquet around the proximal shaft. Curvature severity is documented. The tourniquet is released and the butterfly needle is removed.
A penoscrotal implantation of penile prosthesis with retropubic reservoir placement is performed. Once the implant was in place, significant residual curvature was documented. At this time, the Wilson Manual Modeling maneuver is performed. The mechanisms to protect the implant, urethra, and corportomies are demonstrated. Rubber-shod clamps are placed on the cylinder tubing help to protect the pump. Two fingers are placed on one corporotomy, and the thumb is placed on the other corporotomy. The glans penis is used to protect the urethra. The penis is then bent hard in the direction opposite to the curvature for 90 seconds.
After 90 seconds, the clamps are removed. The modeling may be repeated for another 90 seconds.
After modeling session, the prosthesis is deflated completely and then re-inflated while pulling on the guide sutures of the cylinders to inspect results. It should be noted that the implant should continue to correct hourglass or wasting deformity with time and further expansion.
Disclosures: Consultant: Coloplast, Endo Pharmaceuticals. Speaker: Astellas Pharmaceuticals, Endo Pharmaceuticals