(765) Management of Penile Prosthesis Cylinder Herniation Through Collagen Fleece Graft Site Following Peyronie’s Plaque Excision

Abstract Introduction Penile prosthesis implantation is the current gold standard for patients with PD and concurrent refractory ED. In cases where the IPP placement with or without modeling does not correct penile curvature, Plaque Incision (or excision)and Grafting (PIG/PEG) is a reasonable surgical approach for deformity correction. Several publications have advocated for using collagen fleece grafts rather than sutured grafts to cover the plaque incision site without having to suture near the implant. Cylinder herniation through the graft site is a possible complication of IPP/PEG that has gained increasing attention. Multiple smaller incisions have been proposed to prevent this, but this is not feasible in ossified plaques. Objective present the case and surgical management of cylinder herniation after IPP + PEG with collagen fleece graft. Methods Clinical case: 41-year-old male with history of 90 degree dorsal curvature and severe ED with ossified dorsal plaque. PMH DM2. Presents with concerns of bulging cylinders 4 months after IPP/PEG using collagen fleece. Penis was initially straight. Reports bulging from graft site, with new ventral curvature following inflation. Results excellent cosmetic and functional results. Conclusions Plaque excision at the time of IPP carries the risk of cylinder herniation through the graft site, especially with collagen fleece grafting. When tunical defects are small, collagen fleece grafting is reasonable. For larger defects like those seen with ossified plaques which require excision, sutured grafts are preferred. Repeat graft application via midline ventral penile approach is feasible and is expected to minimize risk of neurovascular injury relative to repeat degloving. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Endo Pharmaceuticals