Penile augmentation in patient with Peyronie's disease. How to improve penile lenght and width with circular and longitudinal grafting and penile implant
Ruffo, A1; Stanojevic, N2; Iacono , F3; Romeo, G1; Romis, L1; Di Lauro, G1
1: Hospital Santa Maria delle Grazie, Italy; 2: Sava Perovic Foundation, Serbia; 3: University of Naples Federico II, Italy
Objectives: Peyronie's disease in severe cases is associated with erectile dysfunction, penile narrowing and shortening affecting patients (pts) psychologically too. The aim of this study is to restore penile shape and size, augmenting length and girth with the use of penile implant and simultaneous albugineal grafting.
Materials and Methods: 13 pts were enrolled. Pts' mean age was 54 +/- 9 years. Mean curvature was 60°. Penile shape was estimated by artificial erection. Surgical approach was performed with peno-scrotal approach. Buck's fascia was dissected with Dartos from the Tunica albuginea. Urethra was mobilized from albuginea. Point of maxime curvature was identified and marked. Transverse and longitudinal incision were performed in order to correct the defects. In pts who required penile widening, two longitudinal lateral incision were done and partially absorbable mesh was used to cover these defects. For transversal grafting a 0.5 mm thick porcine derma was used. 3 piece inflatable penile implant was inserted using the peno-scrotal access. Prostheses was left 70% inflated for 2 weeks. Pts were discharged 2 days postoperatively. Vacuum erectile device was recommended for 6 months.
Results: All pts were satisfied with the result of the surgery. Two pts complained about loss of sensitivity. All pts improved penile length and girth 4.2 cm and 5.3 cm respectively.
Conclusions: Penile implant and albugineal grafting is the only procedure that can restore penile shape. Furthermore it gives the change to augment length and girth comparing to the penile size before the onset of Peyronie's disease. This gain of size lead to high grade of satisfaction rate in this group of treated pts.
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