Minimally invasive intracorporeal incision of Peyronie's plaque: initial experiences with a new technique

Minimally invasive repairs represent an attractive treatment approach for the surgical correction of Peyronie's disease. We describe a novel intracorporeal incision technique and the results of our ongoing experience.

In selected patients who had consented to surgical treatment of a localized Peyronie's scar, saline erection confirmed the degree and location of penile deformity. The skin was mobilized using a subcoronal, circumferential incision. After limited mobilization of the neurovascular bundle, a 1-cm incision lateral to the plaque allowed for the introduction of a triangle-shaped scalpel designed for endoscopic carpal tunnel release into the corpora. Multiple intracorporeal incisions were made, preserving the outer layer of the tunica. Saline erection confirmed curvature correction. A single pair of ventral plication sutures was required in select cases. The small corporotomy, Buck's fascia, and skin were then reapproximated. Patients were discharged home within 24 hours.

In 23 patients, the degree of curvature ranged from 30 degrees to 90 degrees (median 60 degrees). All patients had stable curvature and difficulty with intromission. The mean follow-up was 25 months. Correction of the deformity was successful in all but 2 patients (less than 10 degrees residual curvature), with 80% of patients reporting erections sufficient for intercourse and treatment satisfaction of 85%.

These results indicate good correction of curvature, minimal difficulties with erectile function, and high patient-reported satisfaction using our technique at a follow-up of 25 months. We continue to offer intracorporeal incision as a primary treatment option for discrete plaques less than 2 cm, using grafting techniques for larger and complex lesions.