(347) Comprehensive Surgical Approach to Peyronie’s Disease and Erectile Dysfunction

Abstract Introduction The prevalence of Peyronie’s disease (PD) has been reported to range from 0.4% to 20.3%, with a higher incidence among patients with erectile dysfunction (ED) and diabetes. PD typically affects older men, with a mean age of onset between 50 and 60 years, although younger men under 40 years may also be affected, with a reported prevalence of 1.5–16.9%. Surgical treatment is indicated in patients with significant penile deformity and intercourse difficulties causing sexual distress. Penile prosthesis implantation is usually reserved for patients with PD and concomitant ED who do not respond to conventional medical therapies, such as phosphodiesterase type 5 inhibitors or intracavernous injections of vasoactive agents. Tunical lengthening surgery is preferred in patients presenting with significant penile shortening, severe curvature, and/or complex deformities. Severe curvature is defined as an angulation greater than 60°. On the concave side of the penis, at the point of maximum curvature-typically corresponding to the location of the plaque-an incision is made, creating a defect in the tunica albuginea, which is subsequently covered with a graft. Complete plaque removal or excision has been associated with higher rates of postoperative ED due to venous leakage. If the intraoperative curvature after prosthesis placement is less than 30°, no further action is required. However, if the curvature exceeds 30°, the first-line approach is modelling with the prosthesis maximally inflated. If, after this manoeuvre, a residual deviation greater than 30° persists, further corrective procedures such as incision (and grafting when necessary) should be considered. Objective This video presents three possible surgical alternatives for the treatment of Peyronie’s disease associated with erectile dysfunction. Methods First, we demonstrate a plication (mesh) technique applied to the corpora cavernosa to correct a curvature between 45° and 60°. Second, we show the modelling technique performed with the prosthesis partially inflated in two 90-second cycles. Finally, we present the management of a 90° curvature by plaque incision, coverage with a bovine pericardium graft, and penile prosthesis implantation Results According to published data, grafting techniques achieve success rates between 80% and 90%, while patient satisfaction following penile prosthesis implantation exceeds 90%. The most frequent postoperative complaint is penile shortening. Conclusions In the surgical management of Peyronie’s disease with concomitant erectile dysfunction, a thorough understanding and mastery of all available techniques are essential to ensure optimal outcomes and successful correction of penile deformity Disclosure No