New England Section of the American Urological Association

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Assessment of Novel Extended Manual Modeling Demonstrates Safe and Effective Reduction of Residual Penile Curvature During Penile Prosthesis Implantation
Martin S. Gross, MD1, Lael Reinstatler, MD MPH2, Jacob Lucas, DO3, Ryan Barlotta, DO3, Jay Simhan, MD3
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Einstein Healthcare Network, Philadelphia, PA

BACKGROUND: Described over 20 years ago, manual modeling is an effective strategy at reducing penile curvature in patients with erectile dysfunction (ED) and Peyronie’s Disease (PD) who undergo inflatable penile prosthesis (IPP) insertion. However, due to a lack of contemporary data and a historic 4% rate of urethral perforation, many have opted towards other surgical options for treating concomitant ED and PD. Comparison was made of outcomes in patients undergoing a variant of the original technique (‘extended manual modeling,’ EMM) with patients with no ancillary straightening (NAS) procedure.
METHODS: All IPP cases from 2 high-volume implanters from Nov 2015 through Sept 2018 were reviewed. Patients with > 30° of residual curvature after cylinder placement who underwent EMM were compared to a matched 1:2 cohort of NAS patients. Concomitant grafting and/or plication cases were excluded. EMM was performed by forcibly bending the erect penis in the direction opposite of the point of maximal curvature for 90-second intervals for as many cycles as necessary to achieve <30° curvature.
RESULTS: Of 78 patients in the final analysis, 26 (33.3%) underwent EMM while 52 (66.6%) were in the NAS group. There were no differences in age, race, BMI or medical comorbidity between cohorts. The mean pre-modeling curvature in the EMM group was 47.5° (range 30-90°) while post-modeling curvature improved to a mean of 11.7° (range 0-30°; p<0.0001). An example patient is seen in Figure 1. There was no difference between EMM and NAS cohorts with respect to operative time (93.8 vs 87.3 min, p=0.53) or surgical approach (92% vs 88.5% penoscrotal, p=1.0). Both groups had similar cylinder length and reservoir volume, but patients in the EMM cohort had a smaller mean rear-tip extender (1.1 cm vs 1.8 cm; p=0.006). No patient in either cohort experienced an intraoperative or postoperative complication at a mean follow-up of 19.9 months.
CONCLUSIONS: Although many prosthetic urologists forego manual modeling in cases of severe penile curvature, our contemporary series shows it to be both safe and effective. EMM may preclude the need for more time-consuming and complex surgical procedures.


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