Non-degloving surgical technique with double dorsal-ventral patch graft and penile prosthesis placement for Peyronie's Disease
Clavell Hernandez, J1; Fanag, A2; Wang, R3
1: University of Texas McGovern Medical School at Houston, United States; 2: University of Texas McGovern Medical School at Houston, USA; 3: University of Texas McGovern Medical School at Houston and MD Anderson Cancer Center, USA
Objective: In order to avoid vascular complications such as ischemic injury to the glans, we describe a novel technique that avoids degloving of the penis by utilizing a ventral incision to perform the double dorsal-ventral patch graft, or “sliding technique” (ST) and inflatable penile prosthesis (IPP) placement in patients with severe Peyronie’s Disease (PD).
Methods: Retrospective review of patients with PD and severe erectile dysfunction (ED) who underwent IPP placement with penoplasty by a single surgeon from January 2015 to December 2016. Patient outcomes were recorded for patients who underwent ST with IPP placement with ventral incision and circumcision incision.
Results: 32 patients with PD and severe ED underwent IPP placement with penoplasty. Seven patients (21.9%) had curvature > 60 degrees and underwent IPP placement with grafting procedure, of which 5 underwent ST. Three of these patients underwent ST and IPP placement through a ventral incision. One patient with the circumcision incision reported decrease in glans sensation. There were no vascular complications with either technique. Moreover, this new approach was not only successful in facilitating the ST and PPI in these patients, but also allowed for adequate exposure of the penile shaft with no reported loss of sensation.
Conclusion: While ischemic complications of ST and PPI are rare, there are reports of ischemic injury in patients undergoing a subcoronal circumcising incision with penile degloving. The combination of a circumcising incision and a patient’s underlying peripheral vascular disease potentially raises a patient’s risk of this rare complication. Our innovative non-degloving technique with ventral incision provides an alternative method for ST and PPI in order to avoid penile ischemia, while still allowing for adequate surgical exposure.
Work supported by industry: no.Go Back