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Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference.

Lyons MD, Carson CC, Coward RM - Med Devices (Auckl) (2015)

Bottom Line: The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD.Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting.A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC, USA.

ABSTRACT
Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie's disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

No MeSH data available.


Related in: MedlinePlus

Penile straightening postdevice placement and modeling.
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f3-mder-8-331: Penile straightening postdevice placement and modeling.

Mentions: In the event that significant residual curvature persists following test inflation of the device, penile straightening by manually molding or “modeling” the penis should be attempted (Figures 1–4). Initially described by Wilson and Delk in 1994, modeling is an effective technique for addressing residual curvature postdevice placement.8 With the cylinders fully inflated, the shaft is bent opposite the direction of curvature to rupture the plaque and resolve the curvature. It is important that the exit tubing is clamped to prevent backflow to the pump and to compress the corporotomy sites to prevent cylinder blowout during bending. This procedure can be repeated until the curvature has been resolved.8 Penile modeling requires a high-pressure cylinder, such as the AMS 700 CX (American Medical Systems, Inc.) or Mentor Alpha-1 (Mentor Corporation, Santa Barbara, CA, USA) as studies investigating lower pressure cylinders such as the AMS 700 Ultrex cylinder (American Medical Systems, Minnetonka, MN, USA) and the Mentor Bioflex cylinder (Mentor Worldwide LLC, Santa Barbara, CA, USA) have induced aneurysmal dilatations.9,10 Modeling is the most commonly utilized technique for penile straightening in patients with mild residual curvature after device placement.31


Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference.

Lyons MD, Carson CC, Coward RM - Med Devices (Auckl) (2015)

Penile straightening postdevice placement and modeling.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524455&req=5

f3-mder-8-331: Penile straightening postdevice placement and modeling.
Mentions: In the event that significant residual curvature persists following test inflation of the device, penile straightening by manually molding or “modeling” the penis should be attempted (Figures 1–4). Initially described by Wilson and Delk in 1994, modeling is an effective technique for addressing residual curvature postdevice placement.8 With the cylinders fully inflated, the shaft is bent opposite the direction of curvature to rupture the plaque and resolve the curvature. It is important that the exit tubing is clamped to prevent backflow to the pump and to compress the corporotomy sites to prevent cylinder blowout during bending. This procedure can be repeated until the curvature has been resolved.8 Penile modeling requires a high-pressure cylinder, such as the AMS 700 CX (American Medical Systems, Inc.) or Mentor Alpha-1 (Mentor Corporation, Santa Barbara, CA, USA) as studies investigating lower pressure cylinders such as the AMS 700 Ultrex cylinder (American Medical Systems, Minnetonka, MN, USA) and the Mentor Bioflex cylinder (Mentor Worldwide LLC, Santa Barbara, CA, USA) have induced aneurysmal dilatations.9,10 Modeling is the most commonly utilized technique for penile straightening in patients with mild residual curvature after device placement.31

Bottom Line: The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD.Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting.A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC, USA.

ABSTRACT
Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie's disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.

No MeSH data available.


Related in: MedlinePlus