Plaque incision, grafting and penile prosthesis implantation in Peyronie’s disease

DOI: 10.22591/magyurol.2017.3.kiralyi.106

Authors:
Király István Előd dr., Bajory Zoltán dr.
Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Urológiai Klinika, Szeged (igazgató: Bajory Zoltán dr.)

Summary

Introduction: Peyronie’s disease (PD) is an acquired, benign connective tissue disorder that involves the tunica albuginea of the penis and can cause penile deformity and shortening.
Objective: To show when we use other operation techniques than plication in PD and to show a case report using plaque incision by Egydio technique, grafting and implantation of penile prosthesis at the same time.
Patient and method: The 62-year-old patient had a serious, dorsal curvature. His IIEF-5 score was 6. After the degloving of the penis, we separated the neurovascular bundle from the cavernous bodies and measured the correct place of the double Y shape incision using Egydio technique. After the incision we inserted an AMS Spectra penile implant in the usual way. We used tunica vaginalis parietalis wall of the testis to cover the defect of the tunica albuginea. We closed the Buck fascia and the skin.
Results: No intra- and postoperative complication. The patient started sexual intercourses two month after the operation. The penis is straight, long and wide. The cosmetic and functional results are excellent.
Discussion: Surgery represents the gold standard of treatment of the PD. The indications for surgery are chronic phase of the disease, the sexual intercourse difficult or impossible, failure of conservative management and erectile dysfunction. The main preoperative factors contributing to the decision of the surgical approach are the severity of the curvature, the quality of the erection and the penile length. The main indications of the implantation of penile prosthesis and incision of the plaque plus grafting are severe penile curvatures (above 60 degrees), large dorsal plaques, ventral curvature, and the presence of residual curvature following penile prosthesis implantation and modeling plus tunical incision.
Conclusion: Choosing the right procedure according to the type of deformity, size of the penis, and preoperative erectile function is necessary in order to obtain the best cosmetic and functional results in PD patients.

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