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Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie’s disease and erectile dysfunction: technique and outcomes

International Journal of Impotence Research volume 36, pages 146–150 (2024)Cite this article

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A Comment to this article was published on 20 January 2023

Abstract

Peyronie’s disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie’s disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients’ charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie’s disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck’s fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie’s disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie’s disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0–3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2–2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie’s disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.

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Fig. 1: Scrotal Incision.
Fig. 2: Visualization of entire proximal corpora and urethra without violation of scrotum.
Fig. 3: Two centimeters proximal to coronal sulcus marked.
Fig. 4: One centimeter lateral to urethra marked.
Fig. 5: Extent of TEP from distal marking to ischiocavernosus.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Shirin Razdan, Ariel Zisman & Robert Valenzuela

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  1. Shirin Razdan
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  2. Ariel Zisman
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  3. Robert Valenzuela
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Contributions

SR: data analysis and paper writing. AZ: data analysis and paper writing. RV: study design and final paper review and approval.

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Correspondence to Shirin Razdan.

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Razdan, S., Zisman, A. & Valenzuela, R. Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie’s disease and erectile dysfunction: technique and outcomes. Int J Impot Res 36, 146–150 (2024). https://doi.org/10.1038/s41443-022-00652-7

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