Abstract Introduction Approximately 8% of men with erectile dysfunction (ED) also present with Peyronie’s disease (PD). The primary goal of surgical management is to correct penile curvature and restore penetrative sexual function. Candidates must present with stable disease for at least 9–12 months. Penile prosthesis implantation is generally indicated for patients with PD and concomitant ED refractory to medical therapy, especially in cases of severe curvature (60°) and/or complex deformities. If intraoperative residual curvature after prosthesis placement is 30°, no further correction is required. For residual curvature 30°, the first-line approach is modeling over the maximally inflated prosthesis for 90 seconds. Persistent deviation 30° may necessitate tunical incision with or without collagen fleece coverage. Larger defects can be reconstructed with grafts to prevent herniation or recurrent deformity. Objective This video demonstrates the surgical technique for the management of PD by three-piece penile prosthesis implantation combined with corporal mesh grafting Methods A 60-year-old male presented with a 75° dorsal penile curvature and ED unresponsive to pharmacologic therapy. Surgical correction with penile prosthesis implantation and corporal mesh grafting was planned. Artificial erection was induced to assess curvature. A circumcision and penile degloving were performed, followed by mobilization of the neurovascular bundle from the urethra and elevation with a vessel loop to identify the point of maximal deformity. A mesh incision was made over the corpora cavernosa using monopolar electrocautery to achieve corporal elongation. The tunica albuginea was marked to guide the incision line and facilitate closure after prosthesis insertion. Corporal bodies were incised and sequentially dilated, first with scissors (keeping tips laterally to avoid urethral injury or crossover) and then with dilators to ensure correct distal and proximal expansion, confirming parallel and equidistant alignment. Measurements were obtained proximally and distally. During preparation, the distal component was oriented upward to allow air bubble evacuation. Cylinders were inserted using a Furlow introducer, placing the proximal portion first followed by the distal segment. Corporotomies were closed. The reservoir was placed blindly into the space of Retzius through a rectus fascial puncture just above the pubis and filled with 60 mL of saline. Residual curvature was corrected by modeling for 90 seconds. The pump was positioned in the scrotum with the aid of a rhinolaryngoscope, and all connections were completed. The mesh area was covered with TachoSil to reinforce closure, and the neurovascular bundle was repositioned. The procedure concluded with circumcision, drain placement, and a compressive dressing. Results Operative time: 150 minutes Intraoperative bleeding: Minimal Hospital stay: 28 hours Outcome: Excellent aesthetic and functional result Conclusions The combination of penile prosthesis implantation, corporal mesh, and modeling represents a safe and effective technique for the management of Peyronie’s disease with associated erectile dysfunction. This approach allows for adequate curvature correction without the need for pericardial grafts, thereby reducing infection risk and postoperative morbidity. Disclosure No
Redondo et al. (Mon,) studied this question.