EXPANSION TECHNIC: PENILE LENGTH AND GIRTH ENLARGEMENT WITH MINIMAL TUNICA ALBUGINEA DEFECT WITHOUT GRAFT TO CORRECT PEYRONIE’S DISEASE DURING PENILE PROSTHESIS IMPLANTATION
Some conditions can cause penile length loss, like Peyronie's disease, post radical prostatectomy, erectile dysfunction following ischemic priapism, penile prosthesis reimplantation following removal of an infected penile implant and androgen deprivation therapy.
In 2012 Rolle et al. described the sliding technique to treat patients with Peyronie's disease (PD) and severe erectile dysfunction (ED), during penile prosthesis implantation (PPI), with real length gain of 3.2cm, using a graft to cover the corpora cavernosa defects.
Other authors described modifications in the sliding technique with the intent to reduce the tunica albuginea's defect area, making possible penile implant insertion without graft.
The present work aims to introduce a new "expansion" technique with better distribution of the tunica's defect, a significant reduction of each defect area and no need for graft use during PPI.
Two flexible 3D printed models; one curved and the other, a rectify penis, were used to analyze different ways to perform the tunica albuginea's incision and "expansion" (length and girth enlargement) with reduction of the tunica's defect area and decrease in the number of corpora cavernosa segments.
The best solution generated by the 3D model study was then used to perform the surgery in 4 patients with penile deformity due to Peyronie's disease, severe erectile dysfunction, and complaint of penile length loss.
One case of the "expansion" technic is presented in this video. The patient had 90 degrees of dorsal penile curvature and erectile dysfunction. A penile degloving was made throw penile-scrotal incision. Three circular incisions, in a greek bar pattern, were made in the corpora cavernosa, generating two segments. After the tunica albuginea's expansion, with a penile length gain of 3 centimeters, the segments were stitched together with 4-0 Vicryl.
The Buck's fascia was then closed. A Blake surgical drain was inserted to the scrotum and the wound was closed.
This new surgical procedure was effective on length restoration, correction of penile curvature and hourglass deformity, with minimal defects on tunica albuginea that dispense graft insertion. These findings should be validated through prospective studies with larger samples in the future.
Peyronie's disease; penile enlargement; Penile prosthesis implantation; Graft
Hospital Federal de Ipanema - Rio de Janeiro - Brasil
Alexandre Freitas Miranda