A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie's disease

We developed an algorithm for surgical management and placement of penile p rostheses in patients with erectile failure (ED) and Peyronie's disease (PD ), We identified 46 men ages 40 to 77 y with PD who could not attain an ade quate erection with sexual stimulation and pharmacotherapy, Ail men were ca ndidates for penile straightening and inflatable prosthesis placement using the following algorithm. Manual molding was attempted initially, followed by tunica incision for insufficient straightening, For tunical defects grea ter than 2 cm, polytetrafluoroethylene (PTFE) patch grafting was performed to prevent prosthesis cylinder herniation and recurrent deformity from cica trix: contraction, Mean preoperative penile curvature was 53 degrees (0-90) , Prosthesis implantation with manual molding, implant with plaque incision , and implant with plaque incision and PTFE grading were successfully accom plished in 25 (54%), 12 (29%), and nine (20)% respectively, Mean follow-up was 39 months (range 1-74), Full erectile capacity with a straight phallus was achieved in all patients. Complications included temporary (<8 months) decreased penile sensation in four (9%), mild (< 2 cm) penile shortening in three (7%), delayed ejaculation in one (2%), and infection requiring expla nation in one diabetic male (2%), All of the implanted prostheses provided satisfactory rigidity with no mechanical failures or recurrent curvature, W e conclude that inflatable penile prosthesis implantation is a safe and eff ective therapy with a high satisfaction rate in men with ED and PD, The dev eloped algorithm helps define prosthesis placement and straightening techni ques to obtain optimal results with minimal complications.