Optimal modeling (OM) is an update to the original manual modeling technique that includes performing as many cycles as necessary to achieve the desired penile straightness. Additionally, OM emphasizes the application of significant manual pressure to the distal urethra/glans penis at the fossa navicularis. We believe these two technical adjustments correct the two main complaints levied against manual modeling. This hypothesis was ultimately confirmed by our results, which demonstrated a ~37° improvement in penile curvature (mean 47.8° pre-modeling and 10.6° post-modeling). Further, 87.5% of patients had less than 15° of residual curvature and none required any additional straightening procedures. Importantly, no patients in our study experienced a Clavien-Dindo post-operative complication at a mean follow-up of 29.9 months. Additionally, optimal modeling added only seven minutes of additional operative time.
Optimal modeling advances a time-tested technique for concomitant erectile dysfunction and Peyronie’s disease. It is safe and effective at treating mild to moderate penile curvature at the time of penile prosthesis implantation. Importantly, OM provides a safe and simple solution to the intraoperative dilemma of newly-diagnosed curvature after cylinder inflation. Indeed, many patients who present to high-volume implanters have not had robust erections for some time and may not know they have any significant penile curvature. For such patients, optimal modeling may provide a needed solution with minimal added morbidity. Ultimately, modeling can provide safe and effective straightening while mitigating the risks associated with other straightening procedures.
Written by: Ryan M. Barlotta, DO, Jacob W. Lucas, DO, Jay Simhan, MD, Department of Urology, Einstein Healthcare Network, Philadelphia, PA; Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
Read the Abstract