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

International Journal of Impotence Research volume 36, pages 164–165 (2024)Cite this article

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Despite high patient satisfaction rates amongst men who undergo penile prosthesis placement for refractory erectile dysfunction (ED), perceived penile length and/or girth loss after prosthesis placement is associated with patient dissatisfaction [1,2,3]. It is therefore imperative to appropriately counsel patients pre-operatively regarding realistic post-operative penile length expectations, especially in the setting of Peyronie’s disease where patients may exhibit higher likelihood length or girth loss [4]. Nonetheless, techniques to preserve penile length and minimize girth loss in patients with Peyronie’s disease following prosthesis placement may play an important role in maximizing overall patient satisfaction.

In this article “Scrotal Approach for Tunica Expansion Procedure (TEP) for Penile Girth and Length Restoration in Patients with Penile Angulation due to Peyronie’s Disease and Erectile Dysfunction: Technique and Outcomes”, the authors nicely describe a single-surgeon’s experience with 32 patients with Peyronie’s disease and ED undergoing the modified tunica expansion procedure (TEP) through a scrotal approach at the time of penile prosthesis placement [1]. A thorough, step-by-step description of the modified TEP technique is provided by the authors with great clarity and appears easily replicable. The modified TEP procedure negates the need for a subcoronal incision and avoids the need for grafting. The author’s appropriately highlight their technique’s customizability, with recommendation for preferential tunical scorings at the point of maximal curvature and/or tunical plaque to both correct for angulation and maximize penile length and girth. In their cohort, all patients underwent bilateral modified TEP rather than preferential targeting of penile angulation. Mean degree of penile curvature improved from 20 degrees to 5 degrees. Mean increase in penile length as measured by Furlow dilator was 2.8 cm comparing pre and post penile degloving with modified TEP. Mean increase in girth, measured at midphallus prior to and after IPP insertion, was 1.6 cm. At one year follow up, the authors report no complications [1].

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References

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Authors and Affiliations

  1. New York University Langone Health, Department of Urology, New York, NY, USA

    Ari P. Bernstein & Joel Hillelsohn

  2. Montefiore Medical Center, Department of Urology, Bronx, NY, USA

    Justin Loloi

Authors
  1. Ari P. Bernstein
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  2. Justin Loloi
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  3. Joel Hillelsohn
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Contributions

All authors contributed equally to paper. Authors AB and JL contributed to analyzing data and writing papers and references. Author JH contributed and supervised the complete and final version of the paper and provided editing and revision guidance.

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Correspondence to Ari P. Bernstein.

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Bernstein, A.P., Loloi, J. & Hillelsohn, J. Comment on: “Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration in patients with penile angulation due to Peyronie’s disease and erectile dysfunction: technique and outcomes”. Int J Impot Res 36, 164–165 (2024). https://doi.org/10.1038/s41443-023-00665-w

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