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The clinical significance of imperfection: is idiopathic corporal asymmetry related to curvature during penile prosthesis placement?

International Journal of Impotence Research (2023)Cite this article

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Abstract

Patient satisfaction after inflatable penile prosthesis (IPP) has been linked to preexisting curvature; however the association with intraoperative asymmetric corporal measurements (ACM) has not been well described. We sought to identify incidence of ACM during IPP surgery, and relationship to penile curvature. A retrospective review of all patients undergoing primary IPP placement between 6/2019 and 6/2021 was performed. Logistic regression analysis was performed to identify factors associated with ACM and need for adjunct straightening techniques. A total of 273 patients underwent primary IPP. 27.8% had Peyronie’s disease (PD) diagnosed preoperatively or detected intraoperatively. ACM was identified in 20.1% (55/273) patients. There was no significant difference in ACM in PD versus non-PD patients (p = 0.55). Most patients with ACM (78.2%, 43/55) underwent placement of asymmetric device. ACM did not predict need for invasive straightening maneuvers (p = 0.12). However ACM patients were significantly more likely to have mild residual curvature than those with symmetry (p < 0.0001). Our study is first to address management of idiopathic ACM and association with curvature, providing new insight into a common situation. While ACM was detected in 20%, it did not predict need for adjunct straightening techniques. Our findings may provide reassurance to urologists troubleshooting idiopathic ACM during corporal dilation during IPP surgery.

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Fig. 1: Curvature treatment algorithm.

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Data available from corresponding author on reasonable request.

References

  1. Govier FE, Gibbons RP, Correa RJ, Pritchett TR, Kramer-Levien D. Mechanical reliability, surgical complications, and patient and partner satisfaction of the modern three-piece inflatable penile prosthesis. Urology. 1998;52:282–6.

    Article  CAS  PubMed  Google Scholar 

  2. Mulhall JP, Ahmed A, Branch J, Parker M. Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery. J Urol. 2003;169:1429–33.

    Article  PubMed  Google Scholar 

  3. El-Sakka AI. Prevalence of Peyronie’s disease among patients with erectile dysfunction. Eur Urol. 2006;49:564–9.

    Article  PubMed  Google Scholar 

  4. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015;194:745–53.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Henry GD, Kansal NS, Callaway M, Grigsby T, Henderson J, Noble J, et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol. 2009;181:1264–8.

    Article  PubMed  Google Scholar 

  6. Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50–5.

    Article  CAS  PubMed  Google Scholar 

  7. Henry GD, Jennermann C, Eid JF. Evaluation of satisfaction and axial rigidity with Titan XL cylinders. Adv Urol. 2012;2012:896070.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Scherzer ND, Dick B, Gabrielson AT, Alzweri LM, Hellstrom WJG. Penile prosthesis complications: planning, prevention, and decision making. Sex Med Rev. 2019;7:349–59.

    Article  PubMed  Google Scholar 

  9. Henry GD, Mahle P, Caso J, Eisenhart E, Carrion R, Kramer A. Surgical techniques in penoscrotal implantation of an inflatable penile prosthesis: a guide to increasing patient satisfaction and surgeon ease. Sex Med Rev. 2015;3:36–47.

    Article  PubMed  Google Scholar 

  10. Chung PH, Scott JF, Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie’s disease. J Sex Med. 2014;11:1593–8.

    Article  PubMed  Google Scholar 

  11. Hatzichristodoulou G, Yang DY, Ring JD, Hebert KJ, Ziegelman MJ, Köhler TS. Multicenter experience using collagen fleece for plaque incision with grafting to correct residual curvature at the time of inflatable penile prosthesis placement in patients with peyronie’s disease. J Sex Med. 2020;17:1168–74.

    Article  PubMed  Google Scholar 

  12. Tausch TJ, Chung PH, Siegel JA, Gliga L, Klein AK, Morey AF. Intraoperative decision-making for precise penile straightening during inflatable penile prosthesis surgery. Urology. 2015;86:1048–52.

    Article  PubMed  Google Scholar 

  13. Gupta NK, Ring J, Trost L, Wilson SK, Köhler TS. The penoscrotal surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:628–38.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Agrawal V, Ralph D. An audit of implanted penile prostheses in the UK. BJU Int. 2006;98:393–5.

    Article  PubMed  Google Scholar 

  15. Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National practice patterns of treatment of erectile dysfunction with penile prosthesis implantation. J Urol. 2015;193:2040–4.

    Article  PubMed  Google Scholar 

  16. Lotan Y, Roehrborn CG, McConnell JD, Hendin BN. Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urology. 2003;62:918–21.

    Article  PubMed  Google Scholar 

  17. Akin-Olugbade O, Parker M, Guhring P, Mulhall J. Determinants of patient satisfaction following penile prosthesis surgery. J Sex Med. 2006;3:743–8.

    Article  PubMed  Google Scholar 

  18. Trost LW, Baum N, Hellstrom WJG. Managing the difficult penile prosthesis patient. J Sex Med. 2013;10:893–906; quiz 907.

  19. Welliver C. Optimizing outcomes in the virgin penile implant patient. Curr Urol Rep. 2019;20:14.

    Article  PubMed  Google Scholar 

  20. Welliver C, Kottwitz M, Ahmad AE, Wilson SK, Köhler TS. Manufacturers’ data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol. 2016;34:993–8.

    Article  PubMed  Google Scholar 

  21. Djordjevic ML, Kojovic V. Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie’s disease with erectile dysfunction. Asian J Androl. 2013;15:391–4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lucas JW, Gross MS, Barlotta RM, Sudhakar A, Hoover CRV, Wilson SK, et al. Optimal modeling: an updated method for safely and effectively eliminating curvature during penile prosthesis implantation. Urology. 2020;146:133–9.

    Article  PubMed  Google Scholar 

  23. Deebel NA, Scarberry K, Dutta R, Matz E, Terlecki RP. Salvage penile plication is an effective modality for resolving residual curvature after surgery for peyronie’s disease. Sex Med. 2020;8:686–90.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Berookhim BM, Karpman E, Carrion R. Adjuvant maneuvers for residual curvature correction during penile prosthesis implantation in men with peyronie’s disease. J Sex Med. 2015;12:449–54.

    Article  PubMed  Google Scholar 

  25. Yachia D, Beyar M, Aridogan IA, Dascalu S. The incidence of congenital penile curvature. J Urol. 1993;1501:1478–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA

    Raevti Bole, Manaf Alom, Engy Habashy, Mohammed Ahmed, Matthew Ziegelmann, Tobias Kohler & Sevann Helo

  2. Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Raevti Bole

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  1. Raevti Bole
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Contributions

RB, MA, EH, MA, MZ, TK and SH designed the work/acquired data and played an important role in interpreting the results, RB, MA, EH, MA, MZ, TK and SH drafted or revised the manuscript, RB, MA, EH, MA, MZ, TK and SH approved the final version and RB, MA, EH, MA, MZ, TK and SH agree to be accountable for all aspects of the work.

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Correspondence to Sevann Helo.

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Bole, R., Alom, M., Habashy, E. et al. The clinical significance of imperfection: is idiopathic corporal asymmetry related to curvature during penile prosthesis placement?. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00669-6

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