(316) Penile Prosthesis Placement & Egydio Tunica Expansion Procedure for the Treatment of Severe Curvature in Peyronie’s Disease with Concomitant ED

Abstract Introduction Plaque incision and grafting combined with the implantation of an inflatable penile prosthesis (IPP) is an established surgical technique for correcting severe curvatures due to Peyronie's Disease with concomitant erectile dysfunction. However, the IPP cylinders can bulge, especially when large tunica defects are made. Paulo Egydio has introduced a penile lengthening procedure called the Tunica expansion Procedure (TEP), always followed by IPP placement, which maintains the tunica integrity and eliminates the risk of cylinder bulging and the need for grafting. Objective We present our modification of the Tunica expansion Procedure (TEP) combined with the insertion of an IPP to treat severe curvature due to Peyronie’s disease with concomitant refractory erectile dysfunction. Methods The IPP was left partially inflated for 6 weeks to prevent reclosure of the tunica slits and recurrence of the curvature. Over the next 3 months, the patient was encouraged to cycle the implant several times daily to promote further healing of the tunical defects in the stretched state and prevent shrinkage. Complete penile straightening was observed, which remained constant after 12 weeks.An IPP was implanted via the classic penoscrotal approach, while the cylinders were oversized to 1,5 cm to accommodate the anticipated length gain through the upcoming TEP. After assessing the residual curvature despite the prosthesis being in place, a subcoronal incision with degloving was performed, followed by mobilization of the neurovascular bundle, and modified TEP was performed around the point of maximum curvature. The small slit-shaped defects in the tunica were sealed with a collagen fleece. Results The IPP was left partially inflated for 6 weeks to prevent reclosure of the tunica slits and recurrence of the curvature. Over the next 3 months, the patient was encouraged to cycle the implant several times daily to promote further healing of the tunical defects in the stretched state and prevent shrinkage. Complete penile straightening was observed, which remained constant after 12 weeks. Conclusions In conclusion, this technique allows surgeons to assess the need for additional straightening after IPP implantation based on the degree of residual curvature. Since the primary goal is to straighten the penis and not necessarily to lengthen it, the incisions can mainly be made around the point of maximum curvature, sparing the proximal and distal straight areas of the penile shaft. This reduces unnecessary trauma and prevents overstretching of the neurovascular bundle, thus eliminating the risk of glans necrosis. Finally, the exposure time of the IPP is shortened by using a second subcoronal incision, which reduces the risk of infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston scientific