Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Additional procedures performed at time of penile prosthesis implantation: a review of current literature

International Journal of Impotence Research volume 32, pages 89–98 (2020)Cite this article

Subjects

Abstract

Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie’s Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. We sought to identify the results of available literature regarding the additional procedures performed at the time of penile prosthesis implantation that provide defined surgical outcomes rather than merely describe surgical techniques. Surgical outcomes to procedures provide more realistic clinical outcome for readers than simply the description of novel techniques or expert opinions. We performed a review of the MEDLINE database to identify additional procedures performed in conjunction with penile prosthesis placement. Many procedures are described in review articles, however, with limited data regarding their outcomes. The included articles must describe additional procedures performed in conjunction with penile prosthesis placement. Perioperative office techniques and management were included if it changed the surgical technique. All abstracts obtained through search criteria were reviewed. Only articles written in English, on human subjects with documented surgical results and relevant articles were included in this study. After a thorough literature search, a total of 24 articles were identified. Penile lengthening procedures at the time of penile prosthesis comprise most of the literature on this subject. Lengthening procedures are as simple as Peyronie’s plaque excision and grafting to complex sliding and lengthening procedures requiring complete neurovascular bundle and partial urethral mobilization. Additionally, aggressive cylinder sizing and prolonged postoperative cycling at home are also described. Glanulopexy may be necessary when malpositioning of the glans is present. Other options such as scrotoplasty are also available options for those patients with scrotal webs. Notably there is a paucity of published literature regarding girth enhancement, buried penis repair, hernia repair, and vasectomy at time of penile prosthesis placement. There are numerous procedures that can be performed in the same operative setting as penile prosthesis. Although the procedures do have a common goal to provide optimal postoperative natural appearance, length, straightness, girth and function, the techniques employed must be tailored to each patient as there is not a one-procedure fits all in this patient population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA Guideline. 2018. https://www.auanet.org/guidelines/male-sexual-dysfunction-erectile-dysfunction-(2018).

  2. Nehra A, Alterowitz A, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s disease. 2015. https://www.auanet.org/guidelines/male-sexual-dysfunction-peyronies-disease-(2015).

  3. McCammon KZJM, Jordan, GH. Surgery of the Penis and Urethra. In: Wein AJK, Louis R, Partin AW, Peters CA, editors. Campbell-Walsh Urology, 11th edn. Philadelpha, PA. Elsevier; 2016. p. 907–45.

  4. Palmer LPJS. Management of abnormalities of the external genitalia in boys. In: Wein AJK, Louis R, Partin AW, Peters CA, editors. Campell-Walsh Urology. Philadelphia, PA, Elsevier; 2016, p. 3368–98.

    Google Scholar 

  5. Rigaud G, Berger RE. Corrective procedures for penile shortening due to Peyronie’s disease. J Urol. 1995;153:368–70.

    Article  CAS  PubMed  Google Scholar 

  6. Austoni E, Colombo F, Romano AL, Guarneri A, Kartalas Goumas I, Cazzaniga A. Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie’s disease: a 5-year experience and long-term follow-up on 145 operated patients. Eur Urol. 2005;47:223–9.

    Article  PubMed  Google Scholar 

  7. Egydio PH. Surgical treatment of Peyronie’s disease: choosing the best approach to improve patient satisfaction. Asian J Androl. 2008;10:158–66.

    Article  PubMed  Google Scholar 

  8. Perovic SV, Djinovic RP. Current surgical management of severe peyronie’s disease. Arch Esp Urol. 2010;63:755–70.

    Article  PubMed  Google Scholar 

  9. Silvani M, Pecoraro S, Zucchi A. Corporoplasty for induratio penis plastica with soft axial tutors, single relaxing albugineal incision and safenous grafting. A 3-year follow up. Arch Ital di Urol, Androl: Organo Uff [di] Soc Ital di Ecogr Urol e Nefrol. 2012;84:84–8.

    Google Scholar 

  10. Sansalone S, Garaffa G, Djinovic R, Egydio P, Vespasiani G, Miano R, et al. Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie’s disease, refractory erectile dysfunction, and severe penile shortening. J Sex Med. 2012;9:316–21.

    Article  PubMed  Google Scholar 

  11. Zucchi A, Silvani M, Pecoraro S. Corporoplasty with small soft axial prostheses (VIRILIS I(R)) and bovine pericardial graft (HYDRIX(R)) in Peyronie’s disease. Asian J Androl. 2013;15:275–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, et al. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012;9:2389–95.

    Article  PubMed  Google Scholar 

  13. Rolle L, Falcone M, Ceruti C, Timpano M, Sedigh O, Ralph DJ, et al. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the ‘sliding’ technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117:814–20.

    Article  CAS  PubMed  Google Scholar 

  14. Egydio PH, Kuehhas FE. Penile lengthening and widening without grafting according to a modified ‘sliding’ technique. BJU Int. 2015;116:965–72.

    Article  CAS  PubMed  Google Scholar 

  15. Egydio PH, Kuehhas FE, Valenzuela RJ. Modified sliding technique (MoST) for penile lengthening with insertion of inflatable penile prosthesis. J Sex Med. 2015;12:1100–4.

    Article  PubMed  Google Scholar 

  16. Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3:736–42.

    Article  PubMed  Google Scholar 

  17. Egydio PH, Kuehhas FE, Sansalone S. Penile length and girth restoration in severe Peyronie’s disease using circular and longitudinal grafting. BJU Int. 2013;111:E213–9.

    Article  PubMed  Google Scholar 

  18. Negro CL, Paradiso M, Rocca A, Bardari F. Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures. Asian J Androl. 2016;18:114–7.

    Article  CAS  PubMed  Google Scholar 

  19. Wilson SK, Mora-Estaves C, Egydio P, Ralph D, Habous M, Love C, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144–8.

    Article  PubMed  Google Scholar 

  20. Wilson SK. Rear tip extender sling: a quick and easy repair for crural perforation. J Sex Med. 2010;7:1052–5.

    Article  PubMed  Google Scholar 

  21. Caso J, Keating M, Miranda-Sousa A, Carrion R. Ventral phalloplasty. Asian J Androl. 2008;10:155–7.

    Article  PubMed  Google Scholar 

  22. Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med. 2007;4:1494–9.

    Article  PubMed  Google Scholar 

  23. Carrion R. Ventral phalloplasty. J Sex Med. 2010;7:2914–7.

    Article  PubMed  Google Scholar 

  24. Hakky TS, Wilson SK, Salem EA, Parker J, Carrion R, Mulcahy JJ. Subcoronal rod penile prosthesis placement with scrotoplasty. J Sex Med. 2012;9:2202–5.

    Article  PubMed  Google Scholar 

  25. Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis. J Sex Med. 2015;12:1298–304.

    PubMed  Google Scholar 

  26. Pryor MB, Carrion R, Wang R, Henry G. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis. Asian J Androl. 2016;18:754–8.

    PubMed  Google Scholar 

  27. Levine LA, Becher E, Bella A, Brant W, Kohler T, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine. J Sex Med. 2016;13:489–518.

    Article  PubMed  Google Scholar 

  28. Tsambarlis PN, Chaus F, Levine LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med. 2017;14:44–6.

    Article  PubMed  Google Scholar 

  29. Levine LA, Rybak J. Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study. J Sex Med. 2011;8:2112–7.

    Article  PubMed  Google Scholar 

  30. Mulhall JP, Kim FJ. Reconstructing penile supersonic transporter (SST) deformity using glanulopexy (glans fixation). Urology. 2001;57:1160–2.

    Article  CAS  PubMed  Google Scholar 

  31. Weinberg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Sub-coronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med. 2016;13:270–6.

    Article  PubMed  Google Scholar 

  32. Shaeer O. Shaeer’s glans augmentation technique: a pilot study. J Sex Med. 2012;9:3264–9.

    Article  PubMed  Google Scholar 

  33. Shaeer O. Supersizing the penis following penile prosthesis implantation. J Sex Med. 2010;7:2608–16.

    Article  PubMed  Google Scholar 

  34. Deveci S, Palese M, Parker M, Guhring P, Mulhall JP. Erectile function profiles in men with Peyronie’s disease. J Urol. 2006;175:1807–11.

    Article  PubMed  Google Scholar 

  35. Antonini G, De Berardinis E, Del Giudice F, Busetto GM, Lauretti S, Fragas R, et al. Inflatable penile prosthesis placement, scratch technique and postoperative vacuum therapy as a combined approach to definitive treatment of Peyronie’s disease. J Urol. 2018;200:642–7.

    Article  PubMed  Google Scholar 

  36. Levine LA, Dimitriou RJ. A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease. Int J Impot Res. 2000;12:147–51.

    Article  CAS  PubMed  Google Scholar 

  37. Abern MR, Larsen S, Levine LA. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie’s disease. J Sex Med. 2012;9:288–95.

    Article  CAS  PubMed  Google Scholar 

  38. Yafi FA, Pinsky MR, Stewart C, Sangkum P, Ates E, Trost LW, et al. The effect of duration of penile traction therapy in patients undergoing intralesional injection therapy for Peyronie’s disease. J Urol. 2015;194:754–8.

    Article  PubMed  Google Scholar 

  39. Rybak J, Papagiannopoulos D, Levine L. A retrospective comparative study of traction therapy vs. no traction following tunica albuginea plication or partial excision and grafting for Peyronie’s disease: measured lengths and patient perceptions. J Sex Med. 2012;9:2396–403.

    Article  PubMed  Google Scholar 

  40. Ziegelmann MJ, Alom M, Bole R, Kohler T, Trost L. Modified glanulopexy technique for supersonic transporter deformity and glanular hypermobility in men with penile prostheses. J Sex Med. 2018;15:914–9.

    Article  PubMed  Google Scholar 

  41. Herati AP, Hakky T, Robison J, Martinez D, Carrion R, Lipshultz L. Surgical management of acquired buried penis: experience from two institutions. In: Sexual Medicine Society of North America Annual Meeting. Las Vegas, NV: 2015.

  42. Levine LA, Larsen S. Diagnosis and management of Peyronie’s Disease. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA editors. Campbell-Walsh Urology, 11 edn. Philadelphia, PA. Elsevier: 2016; p. 722–48.

  43. Association AU. Penile Augmentation Surgery. http://www.auanet.org/guidelines/penile-augmentation-surgery, 2013.

  44. Elist JJ, Valenzuela R, Hillelsohn J, Feng T, Hosseini A. A single-surgeon retrospective and preliminary evaluation of the safety and effectiveness of the penuma silicone sleeve implant for elective cosmetic correction of the flaccid penis. J Sex Med. 2018;15:1216–23.

    Article  PubMed  Google Scholar 

  45. Shirvanian V, Lemperle G, Araujo Pinto C, Elist JJ. Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report. Int J Impot Res. 2014;26:100–4.

    Article  CAS  PubMed  Google Scholar 

  46. Kim JJ, Kwak TI, Jeon BG, Cheon J, Moon DG. Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Int J Impot Res. 2004;16:547–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Urology, Rush University Medical Center, 1725 W Harrison Street, Suite 352, Chicago, IL, 60612, USA

    Patrick Whelan MD & Laurence A. Levine

Authors
  1. Patrick Whelan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laurence A. Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurence A. Levine.

Ethics declarations

Conflict of interest

Dr. Laurence Levine is a consultant for Coloplast and Boston Scientific. The remainiing author declares that he has no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Whelan, P., Levine, L.A. Additional procedures performed at time of penile prosthesis implantation: a review of current literature. Int J Impot Res 32, 89–98 (2020). https://doi.org/10.1038/s41443-019-0118-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0118-y

This article is cited by

Search

Advanced search

Quick links