A Novel Penile Splint As Early Traction Therapy After Grafting Techniques For Peyronie's Disease - Beyond The Abstract

Several studies have shown encouraging results on the efficacy and safety of penile traction therapy (PTT) in both the acute and chronic phase of Peyronie’s disease (PD), as well as after PD surgery. However, despite abundant literature on PTT in PD patients, this is the first study evaluating the feasibility, efficacy, and safety of early traction therapy (ETT) after PD surgery (plaque incision and grafting with collagen fleece).

The concept of "early" indicates the application of traction immediately at the end of the surgery, the easiest and cheapest way to apply this type of traction is to build a penis splint. Several studies evaluated the use of penile splints in the last few decades, however, no paper investigated its application in this specific setting. The device was built by the surgeon and applied at the end of the surgical procedure. A cotton wool roll, two 10Ch intubating stylets, two 1/0 polypropylene sutures, and an elastic bandage were the materials to build the device. The assembly time was always less than 5 minutes and the total cost for each penile splint was less than 15 euros.

We maintained the active traction (device with stitches) for 7 days in the majority of patients, then we removed the stitches leaving the device on-site (passive traction) until 3-4 weeks after surgery. Hygiene was not a problem in the first month because wound cleaning and dressing changes were performed every 7 days. After this period, when the circumcision was healed, the penile splint was replaced by a standard penile traction device for at least 4-6 months with intensive daily use.

We hypothesized that the penile splint could prevent the graft shrinkage, from would lead to the preservation of the penile length after surgery reported in our study. On the other hand, the low incidence of hematomas recorded, probably due to the maintenance of the bandage for a longer period of time, could promote the early recovery of sexual activity.

In summary, ETT using our novel penile splint seems to be feasible, effective, and safe. The device is inexpensive, easy to assemble, and adaptable to the patient.

Written by: Celeste Manfredi, MD, Fellow in Andrology and Reconstructive Surgery, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy; Esaú Fernández-Pascual, MD, FEBU, Department of Urology, Hospital Universitario La Paz, Madrid, Spain, LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain; and Juan Ignacio Martínez-Salamanca, MD, PhD, FEBU, FACS, FECSM, Department of Urology, Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain, LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain 

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