Skip to main content

Strategies for Penile Prosthesis Placement in Peyronie’s Disease and Corporal Fibrosis

Abstract

Peyronie’s disease (PD) is a wound healing disorder of the tunica albuginea of the penis. PD is generally categorized into two phases: the early acute inflammatory and late chronic fibrotic. Surgical reconstruction is only recommended during the latter established phase. There are a variety of options when erections are functional. However, when erectile dysfunction is present, the gold standard treatment is the placement of an inflatable penile prosthesis with or without additional straightening procedures. General recommendations include that after implanting and inflating the cylinders, if a clinically significant curvature is present, manual modeling is performed. If a residual curve >30° remains after modeling, then various techniques, including plaque releasing incision, is the next step. Grafting can be considered if tunical defects are >2.0 cm. Causes of corporal fibrosis include complications from an infected implant such as explantation, priapism, penile trauma, and prolonged use of an intracavernosal injection agent. Implant placement in the setting of corporal fibrosis can be technically challenging. Available strategies include incision or excision of the scar, corporotomies with or without grafting, the use of cavernotomes, or other specialized dilators, implant downsizing, and transcorporeal resection.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ralph D, Gonzalez-Cadavid N, Mirone V, et al. The management of Peyronie’s disease: evidence-based 2010 guidelines. J Sex Med. 2010;7(7):2359–74.

    PubMed  Google Scholar 

  2. Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie’s disease. J Urol. 2006;175:2115–8.

    Article  PubMed  Google Scholar 

  3. Nelson CJ, Mulhall JP. Psychological impact of Peyronie’s disease: a review. J Sex Med. 2013;10:653–60.

    Article  PubMed  Google Scholar 

  4. Hatzimouratidis K, Eardley I, Giuliano F, et al. EAU guidelines on penile curvature. Eur Urol. 2012;62(3):543–52.

    Article  PubMed  Google Scholar 

  5. Levine LA, Dimitrou RJ. A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease. Int J Impot Res. 2000;12(3):147–51.

    Article  CAS  PubMed  Google Scholar 

  6. Taylor FL, Abern MR, Levine LA. Predicting erectile dysfunction following surgical correction of Peyronie’s disease without inflatable penile prosthesis placement: vascular assessment and preoperative risk factors. J Sex Med. 2012;9(1):296–301.

    Article  PubMed  Google Scholar 

  7. Levine LA, Lenting E. A surgical algorithm for the treatment of Peyronie’s disease. J Urol. 1997;158:2149–52.

    Article  CAS  PubMed  Google Scholar 

  8. Mulhall JP, Anderson M, Parker M. A surgical algorithm for men with combined Peyronie’s disease and erectile dysfunction: functional and satisfaction outcomes. J Sex Med. 2005;2:132–8.

    Article  PubMed  Google Scholar 

  9. Levine LA, Benson J, Hoover C. Inflatable penile prosthesis placement in men with Peyronie’s disease and drug-resistant erectile dysfunction: a single-center study. J Sex Med. 2010;7:3775–83.

    Article  PubMed  Google Scholar 

  10. Levine LA, Burnett AL. Standard operating procedures for Peyronie’s disease. J Sex Med. 2013;10(1):230–44. Excellent review of the current literature on the surgical options for Peyronie’s disease.

    Article  PubMed  Google Scholar 

  11. Mulhall J, Ahmed A, Anderson M. Penile prosthetic surgery for Peyronie’s disease: defining the need for intraoperative adjuvant maneuvers. J Sex Med. 2004;1:318–21.

    Article  PubMed  Google Scholar 

  12. Zaid UB, Alwaal A, Zhang X, Lue TF. Surgical management of Peyronie’s disease. Curr Urol Rep. 2014;15(10):446. Thorough review of the current literature on the surgical options for Peyronie’s disease.

    Article  PubMed  Google Scholar 

  13. Montorsi F, Guazzoni G, Bergamaschi F, Rigatti P. Patient-partner satisfaction with semirigid penile prostheses for Peyronie’s disease: a 5-year follow-up study. J Urol. 1993;150(6):1819–21.

    CAS  PubMed  Google Scholar 

  14. Ghanem HM, Fahmy I, el-Meliegy A. Malleable penile implants without plaque surgery in the treatment of Peyronie’s disease. Int J Impot Res. 1998;10:171–3.

    Article  CAS  PubMed  Google Scholar 

  15. Wilson SK, Delk 2nd JR. A new treatment for Peyronie’s disease: modeling the penis over an inflatable penile prosthesis. J Urol. 1994;152:1121–3.

    CAS  PubMed  Google Scholar 

  16. Chung E, Solomon M, Deyoung L, Brock GB. Comparison between AMS 700TM CX and ColoplastTM Titan inflatable penile prosthesis for Peyronie’s disease treatment and remodeling: clinical outcomes and patient satisfaction. J Sex Med. 2012;10(11):2855–60. Head-to-head study showing similar positive outcomes with two different inflatable penile prostheses.

    Article  PubMed  Google Scholar 

  17. Levine LA, Larsen SM. Surgery for Peyronie’s disease. Asian J Androl. 2013;15(1):27–34. Comprehensive review of the surgical literature for Peyronie’s disease.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Montague DK, Angermeier KW, Lakin MM, Ingleright BJ. AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie’s disease: comparison of CX and Ultrex cylinders. J Urol. 1996;156:1633–5.

    Article  CAS  PubMed  Google Scholar 

  19. Wilson SK, Cleves MA, Delk JR. Long-term follow-up of treatment for Peyronie’s disease: modeling the penis over an inflatable penile prosthesis. J Urol. 2001;165(3):825–9.

    Article  CAS  PubMed  Google Scholar 

  20. Chung PH, Scott JF, Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie’s disease. J Sex Med. 2014;11:1593–8.

    Article  PubMed  Google Scholar 

  21. DiBlasio CJ, Kurta JM, Botta S, et al. Peyronie’s disease compromises the durability and component-malfunction rates in patients implanted with an inflatable penile prosthesis. BJU Int. 2010;106(5):691–4.

    Article  PubMed  Google Scholar 

  22. Carson CC, Levine LA. Outcomes of surgical treatment of Peyronie’s disease. BJU Int. 2014;113(5):704–13. State-of-the-art review of the surgical options for Peyronie’s disease.

    Article  PubMed  Google Scholar 

  23. Wang R, Howard GE, Hoang A, Yuan JH, Lin HC, Dai YT. Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection. Asian J Androl. 2009;11(4):411–5.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Egydio PH, Sansalone S. Peyronie’s reconstruction for maximum length and girth gain: geometrical principles. Adv Urol. 2008;205739.

  25. Egydio PH, Kuehhas FE, Sansalone S. Penile length and girth restoration in severe Peyronie’s disease using circular and longitudinal grafting. BJU Int. 2013;111:E213–9. New interesting technique to preserve penile length and girth using geometrical principles.

    Article  PubMed  Google Scholar 

  26. Rolle L, Ceruti C, Timpano M, et al. A new, innovative lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the ”sliding technique”. J Sex Med. 2012;9(9):2389–95.

    Article  PubMed  Google Scholar 

  27. Sansalone S, Garaffa G, Djinovic R, et al. Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie’s disease, refractory erectile dysfunction, and severe penile shortening. J Sex Med. 2012;9:316–21.

    Article  PubMed  Google Scholar 

  28. Shaeer O. Supersizing the penis following penile prosthesis implantation. J Sex Med. 2010;7(7):2608–16.

    PubMed  Google Scholar 

  29. Shaeer O. Trans-corporal incision of Peyronie’s plaques. J Sex Med. 2011;8(2):589–93. Innovative technique to incise a Peyronie’s plaque using endoscopic equipment.

    Article  PubMed  Google Scholar 

  30. Silvani M, Pecoraro S, Zucchi A. Corporoplasty for induratio penis plastica with soft axial tutors, single relaxing albugineal incision and safenous grafting. A 3-year follow up. Arch Ital Urol Androl. 2012;84(2):84–8.

    PubMed  Google Scholar 

  31. Austoni E, Colombo F, Romano AL, et al. Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie’s disease: a 5-year experience and long-term follow-up on 145 operated patients. Eur Urol. 2005;47(2):223–9.

    Article  PubMed  Google Scholar 

  32. Grasso M, Lania C, Fortuna F, Blanco S, Piacentini I. Preservation of cavernosal erectile function after soft penile prosthesis implant in Peyronie’s disease: long-term follow-up. Adv Urol. 2008;646052.

  33. Zucchi A, Silvani M, Pecoraro S. Corporoplasty with small soft axial prostheses (VIRILIS I®) and bovine pericardial graft (HYDRIX®) in Peyronie’s disease. Asian J Androl. 2013;15(2):275–9.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Levine LA, Greenfield JM, Estrada CR. Erectile dysfunction following surgical correction of Peyronie’s disease and a pilot study of the use of sildenafil citrate rehabilitation for postoperative erectile dysfunction. J Sex Med. 2005;2(2):241–7.

    Article  PubMed  Google Scholar 

  35. Segal RL, Burnett AL. Surgical management for Peyronie’s disease. World J Mens Health. 2013;31(1):1–11. Good review of the surgical knowledge on Peyronie’s disease.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Levine LA, Rybak J. Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study. J Sex Med. 2011;8(7):2112–7.

    Article  PubMed  Google Scholar 

  37. Martínez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med. 2011;8(7):1880–9. Best available review on the different techniques used for penile prosthesis surgery with corporal fibrosis.

    Article  PubMed  Google Scholar 

  38. Jordan GH, Angermeier KW. Preoperative evaluation of erectile function with dynamic infusion cavernosometry/cavernosography in patients undergoing surgery for Peyronie’s disease: correlation with postoperative results. J Urol. 1993;150(4):1138–42.

    CAS  PubMed  Google Scholar 

  39. Rajpurkar AA, Li HH, Dhabuwala CCB. Penile implant success in patients with corporal fibrosis using multiple incisions and minimal scar tissue excision. Urology. 1999;54:145–7.

    Article  CAS  PubMed  Google Scholar 

  40. Montague DK, Angermeier KW. Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis. Urology. 2006;67:1072–5.

    Article  PubMed  Google Scholar 

  41. Shaeer OO, Shaeer AA. Corporoscopic excavation of the fibrosed corpora cavernosal for penile prosthesis implantation: optical corporotomy and trans-corporeal resection, Shaeer’s technique. J Sex Med. 2007;4:218–25.

    Article  PubMed  Google Scholar 

  42. Shaeer O. Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med. 2007;4:809–14.

    Article  PubMed  Google Scholar 

  43. Sansalone S et al. Simultaneous total corporal reconstruction and implantation of a penile prosthesis in patients with erectile dysfunction and severe fibrosis of the corpora cavernosa. J Sex Med. 2012;9(7):1937–44.

    Article  PubMed  Google Scholar 

  44. Summerton DJ, Terry TR, Delk JR, Wilson SK. Reimplantation of inflatable penile prostheses (IPP) into scarred corporeal bodies facilitated by the new AMS 700 CXR cylinders. BJU Int. 2005;95:102.

    Article  Google Scholar 

  45. Knoll LD, Furlow WL, Benson Jr RC, Bilhartz DL. Management of nondilatable cavernous fibrosis with the use of a downsized inflatable penile prosthesis. J Urol. 1995;153(2):366–7.

    Article  CAS  PubMed  Google Scholar 

  46. Egydio PH, Kuehhas FE. Distal penile shaft reconstruction and reinforcement: the “double-windsocks” technique. J Sex Med. 2013;10(10):2571–8. Innovative technique using grafts to create neocorpora.

    PubMed  Google Scholar 

  47. Szostak MJ, DelPizzo JJ, Sklar GN. The plug and patch: a new technique for repair of corporal perforation during placement of penile prostheses. J Urol. 2000;163(4):1203–5.

    Article  CAS  PubMed  Google Scholar 

  48. Mulcahy JJ. Crural perforation during penile prosthetic surgery. J Sex Med. 2006;3(1):177–80.

    Article  PubMed  Google Scholar 

  49. Kohler TS, Modder JK, Dupree JM, Bush NC, McVary KT. Malleable implant substitution for the management of penile prosthesis pump erosion: a pilot study. J Sex Med. 2009;6:1474–8.

    Article  PubMed  Google Scholar 

  50. Knoll LD, Fisher J, Benson Jr RC, Bilhartz DL, Minich PJ, Furlow WL. Treatment of penile fibrosis with prosthetic implantation and flap advancement with tissue debulking. J Urol. 1996;156:394–7.

    Article  CAS  PubMed  Google Scholar 

  51. Borges F, Hakim L, Kline C. Surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via infrapubic approach. J Sex Med. 2006;3:550–3.

    Article  PubMed  Google Scholar 

  52. Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3:736–42.

    Article  PubMed  Google Scholar 

  53. Swords K, Martinez DR, Lockhart JL, Carrion R. A preliminary report on the usage of an intracorporal antibiotic cast with synthetic high purity CaSO4 for the treatment of infected penile implant. J Sex Med. 2013;10:1162–9.

    Article  CAS  PubMed  Google Scholar 

  54. Trost LW, Baum N, Hellstrom WJ. Managing the difficult penile prosthesis patient. J Sex Med. 2013;10(4):893–906. Excellent review of factors that cause patient satisfaction or dissatisfaction following penile prosthesis placement.

    Article  PubMed  Google Scholar 

  55. Eid JF, Wilson SK, Cleves M, Salem EA. Coated implants and "no touch" surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%. Urology. 2012;79(6):1310–5.

    Article  PubMed  Google Scholar 

  56. Lynch MJ, Scott GM, Inglis JA, Pryor JP. Reducing the loss of implants following penile prosthetic surgery. Br J Urol. 1994;73:423–7.

    Article  CAS  PubMed  Google Scholar 

  57. Mulcahy JJ, Carson 3rd CC. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60:167–72.

    Article  PubMed  Google Scholar 

  58. Radomski SB, Herschorn S. Risk factors associated with penile prosthesis infection. J Urol. 1992;147:383–5.

    CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Faysal A Yafi, Dr. Premsant Sangkum, and Dr. Ian Ross McCaslin each declare no potential conflicts of interest.

Dr. Wayne J. G. Hellstrom reports personal fees from Coloplast; personal fees from American Medical Systems; personal fees from Antares; grants from Auxilium; personal fees from Endo; personal fees from Lilly, USA; personal fees from New England Research Institutes, Inc; personal fees from Promescent, other from NIH, and other from Theralogix.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wayne J. G. Hellstrom.

Additional information

This article is part of the Topical Collection on Men’s Health

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yafi, F.A., Sangkum, P., McCaslin, I.R. et al. Strategies for Penile Prosthesis Placement in Peyronie’s Disease and Corporal Fibrosis. Curr Urol Rep 16, 21 (2015). https://doi.org/10.1007/s11934-015-0491-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-015-0491-0

Keywords

  • Penile prosthesis
  • Peyronie’s disease
  • Degree of curvature
  • Corporal fibrosis
  • Erectile dysfunction
  • Manual modeling