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Comment on “Comparison of patient-reported outcomes after penile prosthesis placement in men with and without Peyronie’s disease”

International Journal of Impotence Research volume 35, pages 577–578 (2023)Cite this article

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The Original Article was published on 29 August 2022

The three-piece inflatable penile prosthesis implant procedure has undergone tremendous technical advancements; however, it is not without surgical hazards and can have additional cosmetic and psychosocial consequences in poorly chosen and consenting individuals [1]. In order to get the best clinical results, the International Penile Prosthesis Implant Consensus Forum determined that careful patient selection, informed consent, and strict adherence to safe surgical standards are essential [1]. Furthermore, they emphasize that patients with Peyronie’s disease (PD)-related corporal fibrosis are challenging cases that necessitate extra attention and cutting-edge surgical methods to get the best possible surgical results [1]. They also came to the conclusion that in order to optimize the evaluation of outcomes across patient groups, the variability in patient care - in terms of postoperative antibiotic use, pain treatment, scrotal care, and cycling of the penile prosthesis implant - must be reduced [1]. Therefore, single surgeon data evaluating the results across patient groups could be very valuable until penile implant surgeons come to an agreement over patient care [1]. In the recent article from Ziegelmann M et al., the authors try to compare patient-reported outcomes after penile prosthesis placement through a single surgeon in men with and without PD [2].

Penile prosthesis implantation (PPI) can be challenging in patients with concurrent PD and residual curvature > 30° degrees. There are five main categories of surgical techniques for penile straightening during PPI: implantation of the prosthesis alone, penile modeling, plication of the penis on the convex side of the curvature, plaque incision(s), and plaque incision/excision plus grafting [3, 4]. Ziegelmann et al. mentioned that patients with significant residual curvature after the placement of the penile prosthesis cylinders and manual modeling were usually treated with plaque incision with or without grafting [2]. The authors rarely performed penile plication due to the potential to further exacerbate penile shortening, which is an already significant concern for most men with PD [2]. If the defect size created by the incisions was >2 cm, grafting was carried out using either a sutured human pericardial allograft Tutoplast (Coloplast, Minneapolis, MN, USA) or a hemostatic patch such as Evarrest (Ethicon Inc, Somerville, NJ) or TachoSil (Baxter Healthcare Corp, Deerfield, IL) [2]. The latter was also their preferred grafting material. More and more reconstruction urologists throughout the world prefer and advise TachoSil after it successfully navigated the clinical pipeline. Despite the currently limited proof, it offers some important advantages as a grafting material [5]. These advantages include: (1) simple application due to its self-adhesiveness; (2) zero chance of injuring or puncturing the implant due to the avoidance of suturing; (3) shorter operating times due to the lack of suture fixation; (4) preservation or even growth of penile length due to its low risk of contraction; (5) decreased incidence of penile hypesthesia due to its quick and simple application reducing traction to the neurovascular bundle, which in turn prevents its injury; (6) Minimal risk of other negative events, such as infection and hematoma due to its extra hemostatic effects; and (7) low cost due to the fact that it is an easily accessible, off-the-shelf sealing patch [5].

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References

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  1. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany

    Ioannis Sokolakis

  2. School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Sokolakis

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Sokolakis, I. Comment on “Comparison of patient-reported outcomes after penile prosthesis placement in men with and without Peyronie’s disease”. Int J Impot Res 35, 577–578 (2023). https://doi.org/10.1038/s41443-022-00626-9

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