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Penile lengthening and widening without grafting according to a modified 'sliding' technique
Paulo H Egydio1, Franklin E Kuehhas2
1Centre for Peyronie's Disease Reconstruction, Sao Paulo, Brazil.
Objective:
To present the feasibility and safety of penile length and girth restoration based on a modified 'sliding' technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD).
Patients And Methods:
Between January 2013 and January 2014, 143 patients underwent our modified 'sliding' technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow-shaped tunical defects with Buck's fascia only.
Results:
In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0-100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1-7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow-up was 9.7 (6-18) months. The mean (range) penile length gain was 3.1 (2-7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6-month follow-up.
Conclusion:
Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.
Insights
This study demonstrates a modified sliding technique effectively restores penile length and girth in men with severe erectile dysfunction and penile shortening. The procedure is safe, improves erectile function, and avoids grafting, reducing infection risk and costs.
Area of Science:
- Urology
- Andrology
- Reconstructive Surgery
Background:
- Severe erectile dysfunction (ED) and penile shortening, often associated with Peyronie's disease (PD), present significant challenges.
- Existing surgical options for penile restoration may involve complex techniques with potential complications.
- Restoration of both penile length and girth is crucial for patient satisfaction and functional recovery.
Purpose of the Study:
- To evaluate the feasibility and safety of a modified 'sliding' technique for penile length and girth restoration.
- To assess the efficacy of this technique in patients with severe ED and significant penile shortening, with or without PD.
- To determine the impact on erectile function and patient-reported outcomes.
Main Methods:
- A modified 'sliding' technique was employed for penile length and girth restoration in 143 patients between January 2013 and January 2014.
- The technique involves a sliding maneuver for length, optional tunical incisions for girth, and closure with Buck's fascia only, avoiding grafting.
- Concomitant penile prosthesis implantation was performed in all patients; follow-up averaged 9.7 months.
Main Results:
- The procedure was performed on 143 patients with various causes of penile shortening, including PD (53.8%) and ED (21%).
- Mean penile length gain was 3.1 cm, and subjective penile shortening was reduced.
- International Index of Erectile Function (IIEF) scores significantly improved from a baseline of 24 to 60 at 6-month follow-up; no device explantation due to infection occurred.
Conclusions:
- The modified sliding technique is a safe and effective method for penile length and girth restoration in patients with ED and penile shortening.
- Eliminating the need for grafting reduces operative time, lowers infection risk, and decreases overall surgical costs.
- The technique demonstrates significant functional improvement in erectile function.
