(342) Penile Prosthesis Placement With Mesh-Type Relaxing Incisions in Peyronie’s Disease

Abstract Introduction Peyronie’s disease, characterized by the formation of fibrotic plaques in the tunica albuginea, can cause severe penile deformities that impair sexual function. In some cases, penile curvature is corrected by prosthesis placement alone, while in others, additional maneuvers are required. Objective We present the case of a 61-year-old man, former smoker, with type 2 diabetes mellitus and hypertension, who presented with a penile curvature greater than 90° that prevented penetration. Methods The patient had a buried, poorly stretchable penis measuring 8 cm in stretched length, with a suprapubic fat pad and a dorsal plaque in the midshaft. Doppler ultrasound following intracavernosal administration of 20 mg alprostadil confirmed a left dorsolateral curvature of 110°. Penile prosthesis implantation with relaxing incisions was planned. Results Intraoperative Gittes test confirmed the 110° curvature. A subcoronal approach with degloving was performed, followed by opening of Buck’s fascia and dissection of the neurovascular bundle. Mesh-type relaxing incisions were made in the tunica albuginea, achieving a penile length of 10 cm. An inflatable penile prothesis measuring 16+1 was subsequently implanted. To correct the residual curvature, modeling was performed, resulting in a final curvature of less than 30°. Tachosil was applied to cover the tunical defects. The reservoir was placed in the right paravesical position with 60 cc of saline, and the pump was located in the scrotum. A vacuum drain was placed in the scrotum. The procedure resulted in satisfactory correction of penile curvature, with a final length of 10 cm. The patient was discharged 24 hours postoperatively without a drain and with an uneventful recovery. Conclusions The combination of relaxing incisions in the tunica albuginea, modeling, and penile prosthesis implantation is an effective technique for the management of severe curvature in Peyronie’s disease associated with erectile dysfunction. Disclosure No