Abstract Introduction Peyronie’s disease (PD) with coexisting erectile dysfunction (ED) presents a significant surgical challenge, particularly in patients with severe curvature. Penile prosthesis implantation alone may not fully correct deformity, and additional straightening maneuvers are often required. We present the combined surgical approach of plaque incision and grafting with inflatable penile prosthesis (IPP) implantation in a patient with disabling curvature and ED refractory to medical therapy. Objective To demonstrate the feasibility and effectiveness of plaque incision and grafting performed in conjunction with penile prosthesis implantation, highlighting the operative steps, perioperative considerations, and early postoperative outcomes in a complex case of severe PD with ED. Methods Through a midline penoscrotal incision, corporal dilation was performed and inflatable cylinders inserted. After full inflation, the curvature persisted, necessitating elevation of the neurovascular bundle. A transverse plaque incision was then performed at the area of maximum curvature over the dorsal aspect using low-energy cautery. A tailored bovine pericardial graft was then sutured to cover the tunical defect with 3-0 absorbable sutures, ensuring preservation of dimensions. Cylinder inflation confirmed satisfactory straightening. Buck’s fascia and skin were closed in layers, with placement of a closed suction drain due to extensive dissection. Results The procedure achieved complete correction of curvature with optimal prosthesis function. Postoperative recovery was uneventful, and the patient was discharged on day three. At three-month follow-up, the patient reported satisfactory sexual intercourse, penile straightness, and no device-related complications. Conclusions Plaque incision and grafting in combination with penile prosthesis implantation is a valuable technique in selected patients with severe PD and refractory ED. It allows for simultaneous correction of curvature and restoration of erectile function, with favorable early outcomes. Disclosure No
A Majzoub (Mon,) studied this question.