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Published on: March 15, 2024
A multicenter evaluation of penile curvature correction in men with Peyronie's disease undergoing inflatable penile
Muhammed A M Hammad1, David W Barham2, Jay Simhan3
1Department of Urology, University of California, Irvine, Orange, CA 92868, United States.
Background:
Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement.
Aim:
To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort.
Methods:
A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons. Demographic, intraoperative, and postoperative data were analyzed to assess the improvement in penile curvature following IPP, including adjunctive correction techniques such as manual modeling, tunica albuginea plication, and grafting.
Outcomes:
Curvature correction achieved after IPP placement and adjunctive procedures.
Results:
For 499 PD patients treated with IPP, median age was 62.0 [30.0, 91.0] years with mean follow-up of 16.5 (SD = 12.9) months. The mean preoperative curvature was 39.4° (SD = 17.8°), with dorsal curvature being most common. Among our cohort, 17.6% had IPP-only placement, while the majority of 82.4% patients underwent IPP along with adjunctive correction procedures. Specifically, manual modeling (with/without the "scratch" technique) was used in 74.7% of cases, tunica albuginea plication in 4.8%, grafting in 2%, and combined grafting and modeling in 0.8%. Patients who underwent grafting generally had fewer preoperative comorbidities and more severe preoperative curvatures of 60.0° [45.0°, 70.0°]. Grafting also provided the highest median curvature correction of 55.0° [48.8°, 73.8°], (P < .001). Plication achieved a median curvature correction of 40.0° [28.8°, 41.2°], whereas modeling resulted in a median curvature reduction of 26.0° [20.0°, 39.5°], (P < .001).
Clinical Implications:
We observed that grafting, though less frequently used, provided more curvature correction in severe PD cases undergoing IPP.
Strengths And Limitations:
Large cohort size and multinational participation are strengths, though retrospective design and general variability in surgical techniques are limitations.
Conclusion:
Adjunctive techniques, including grafting, plication, and modeling provide options for tailoring curvature correction to disease severity and patient characteristics. Future prospective studies are needed to standardize and evaluate the comparative outcomes of these techniques.
