Inflatable Penile Prosthesis Placement, "Scratch Technique", and Postoperative Vacuum Therapy as a Combined Approach in the Definitive Treatment of Patients with Peyronie's Disease

Peyronie's disease (PD) is a devastating condition resulting in penile deformity, erectile dysfunction (ED), pain and emotional distress. This prospective two institution study evaluates a multimodal surgical and mechanical combined approach in the definitive treatment of PD and concomitant ED.

145 selected patients underwent endocavernosal disruption of the PD plaques via the "scratch technique" followed by inflatable penile prosthesis (IPP) insertion. Postoperatively, patients were assigned vacuum device therapy for 3 minutes twice daily in order to continue penile curvature correction. Follow-up continued for one year after surgery. Anatomical and functional results were assessed.

Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean residual curvature of 21.5 ± 4.5°, 17.3 ± 4.8° and 14.1 ± 3.1° respectively after surgery. After 24 weeks of vacuum therapy, penile curvature deviation decreased to 8.7 ± 2.5°, 9.1 ± 2.9° and 7.7 ± 0.9° respectively. Preoperative mean IIEF-5 score was 9.8 ± 2.3, at 6 months 18.9 ± 3.1 (p<0.001) and at 1 year was 24.1 ± 3.6 (p<0.001). Mean EDITS score at the end of the follow up was 64.6 ± 11.8. Operative and postoperative complications were minimal.

Our novel combination of intraoperative and postoperative therapies in the treatment of patients with PD and IPP is safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.

The Journal of urology. 2018 Apr 17 [Epub ahead of print]

G Antonini, E De Berardinis, F Del Giudice, G M Busetto, S Lauretti, R Fragas, B I Chung, S L Conti, D Giannarelli, I Sperduti, M S Gross, P E Perito

Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy., Department of Urology, Santa Caterina della Rosa Clinic ASL RM-C, Rome, Italy., Clinica Central Cira Garcia, La Havana, Cuba., Department of Urology, Stanford University Medical Center, Stanford, CA, USA., Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy., Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA., Department of Urology, Coral Gables Hospital, Coral Gables, FL, USA.

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