(541) Use of an Auxetic Surgical Technique to Correct Penile Deformities in Peyronie's Disease During Inflatable Prosthesis Implantation: Clinical Case Series

Abstract Introduction Peyronie's disease (PD) causes penile curvature, narrowing, and shortening, often with loss of penile length, girth, and volume. Erectile dysfunction affects nearly half of these patients, making penile prosthesis implantation a standard treatment.1 The recently introduced Auxetic technique enables multidimensional tunical expansion and restoration of penile dimensions without grafting.2 Objective The objective of this study is to describe the initial application of the Auxetic technique in 19 cases of PD associated with ED. Methods From November 2019 to December 2024, 16 consecutive patients with PD associated with ED, with a mean age of 59 years (47 to 74 years), were enrolled in this study. They were submitted to penile prosthesis implantation after tunica albuginea incision using a new auxetic guide device to generate the standardized star shape incision on the corpora cavernosa. The incisions create a rotating triangles system, which generates the tunica albuginea expansion in two dimensions (longitudinal and transversal), resulting in tissue increasement, correcting the penile deformity Figure 1. During the surgery, measurements of penile length and girth, curvature degree, and the presence of hourglass deformity were recorded. At the conclusion of the procedure, the penis was reevaluated to confirm whether the deformity had been completely corrected. Additionally, intraoperative and postoperative complications were documented and classified using the Clavien-Dindo grading system. Postoperative patient satisfaction was also assessed. Results Among the 19 patients who underwent surgery, 9 presented with uniplanar penile curvatures, 10 with multiplanar curvatures, and 7 exhibited hourglass deformities. In multiplanar cases, curvature angles ranged from 10 to 110o across each plane. In uniplanar cases, the mean curvature angle was 72o, with a range from 50 to 90o. The mean reduction in penile circumference at hourglass deformity point was 1.2 cm, and the average subjective penile length loss was 2.6 cm. The average operative time was 131 minutes. No major intraoperative complications were observed. 7 patients received inflatable penile implants while 12 received malleable penile prostheses. Postoperatively, a total of 2 patients experienced complications: 1 was classified as Clavien-Dindo grade I, and one patient was classified as grade IIIa, requiring surgical correction for paraphimosis. Patients were discharged after 24 - 48 hours. The average increase in penile length was 2.0 cm, and girth expanded by 1.0 cm following the implantation of inflatable penile prostheses. The mean penile volume increased from 157 cm3 preoperatively to 212 cm3 postoperatively, representing an approximate 35% volumetric gain. Additionally, all penile deformities were successfully corrected after the auxetic incisions. No other complications were noted after a mean follow-up period of 36.8 months (10 to 70 months). 15 patients were very satisfied and 4 were moderated satisfied with the result and all of them would undergo the surgery again. Conclusions The auxetic technique proved to be a safe and effective method for correcting penile deformities, enabling simultaneous restoration of length, girth, and penile volume during prosthesis implantation, without the need for grafts. Disclosure No