Moderated Poster
Pramod Krishnappa, MD, DNB, FNAMS
NU Hospitals
Presentation Authors: Ignacio Moncada, Madrid, Spain, Pramod Krishnappa*, Bangalore, India
Introduction: Penile prosthesis(PP) becomes the mainstay of the management in patients with Peyronies disease(PD) with coexistent erectile dysfunction(ED). One of the major challenges is to deal with the residual curvature after the PP implantation. After the introduction of manual-modeling(MM) on inflatable PP(IPP) in the operating room (OR) by Wilson S et al in 1994, the need for additional surgical maneuvers such as incision-grafting has reduced. Nevertheless, in many series, as many as upto 40% of patients need surgical correction of the curvature in addition to IPP. These additional surgical maneuvers entail a greater potential of complications including infection and higher costs. We highlight the importance of home-modeling(HM) in patients who have residual curvature after IPP
Methods: A retrospective review was performed of all patients diagnosed with PD who underwent IPP insertion between 2008 and 2017. All patients received AMS 700-CX IPP. After implantation, the IPP was inflated to maximum and curvature was measured. All patients underwent subsequent Wilson MM in the OR. If residual curvature was more than 45 degree, circumcision and incision-grafting were performed. Rest of the patients were instructed to perform HM after 4 weeks from implantation. The HM protocol consisted of i)full inflation of the IPP and gently bending (modeling) the penis in the opposite direction of the curvature, ii)each cycle consisted of holding the penis in this stretched position for 30 seconds, and then subsequently deflating the prosthesis, iii)such multiple cycles were done in each episode lasting for 20 min and iv)such 3 episodes were done every day for 6 months Demographic and surgical data were collected from the patients medical records. Improvement in penile curvature and patient satisfaction were assessed postoperatively using a non-validated questionnaire. The main outcome measure was the residual curvature at 6 months postoperatively
Results: The mean age of the study group was 63 years(52-79). A total of 92 patients with PD and coexistent ED received IPP. The mean preoperative penile curvature was 39 degree(30-60). 16(17.4%) patients required incision-grafting and the remaining 76(82.6%) patients followed HM protocol. The mean postoperative residual curvature after MM was 30 degree(5-50). Sixty-five(85.5%) patients who underwent HM had 10 degrees or less residual curvature after 3 months and 72(94.7%) patients had 10 degrees or less residual curvature after 6 months. Seventy(92.1%) patients responded as satisfied or very satisfied on the questionnaire with the outcome after 6 months
Conclusions: HM of the penis over IPP may straighten the penis without the need for an additional surgical maneuver in a vast majority of the PD patients having residual curvature of less than 45 degrees