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A Multicenter Evaluation of Penile Curvature Correction in Men with Peyronie's Disease Undergoing Inflatable Penile Prosthesis Placement
Britney L. Atwater, MD1, Thomas Alvermann, BS2, David W. Barham, MD3, Muhammed A.M. Hammad, MBBS3, Chrystal Chang, MD4, Daniel Swerdloff, MD4, Jake Miller, MD3, Kelli Gross, MD5, Georgios Hatzichristodoulou, MD6, James M. Jones, BA2, James M. Hotaling, MD5, Vaibhav Modgil, MD7, Ian Pearce, MD7, Hossein Sadeghi-Nejad, MD8, Jay Simhan, MD4, Faysal A. Yafi, MD3, Martin S. Gross, MD1.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 3University of California, Irvine, Orange, CA, USA, 4Fox Chase Cancer Center, Philadelphia, PA, USA, 5University of Utah, Salt Lake City, UT, USA, 6Martha-Maria Hospital Nuremberg, Nuremberg, Germany, 7Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom, 8Rutgers New Jersey Medical School, Newark, NJ, USA.

Background: Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's Disease (PD) and significant erectile dysfunction (ED). Adjunctive procedures such as modeling, plication, or incision/excision and grafting can be used when there is residual curvature after IPP placement. We aim to evaluate the management of curvature correction in patients with PD undergoing IPP among high volume prosthetic urologists. Methods: We performed a retrospective study of 205 patients diagnosed with PD undergoing IPP by 7 high volume penile prosthetic surgeons. Demographic, intraoperative, and postoperative data were collected and analyzed. Descriptive statistics were performed using mean and standard deviation for continuous variables, while incidence and percentages were used for categorical variables. We calculated the mean change in penile curvature after IPP insertion for each of the adjunctive correction techniques. Intra- and post-operative complications were collected. Results: 205 patients met inclusion criteria with a mean age of 60.7 years (SD=9.2) and a median follow-up of 6 months (0.5-58.5 months). The mean preoperative curvature was 43.4 (SD=18.9) with dorsal curvature being the most common. Overall, 73 (35.6%) patients had IPP only with no adjunctive curvature correction procedure, 24 (11.7%) underwent plication, 10 (4.9%) underwent grafting, and 98 (47.8%) underwent modeling. Preoperatively, the mean starting curvature was 35.7 for the IPP only group, 48.1 for the plication group, 60.6 for the grafting group, and 46.0 for the modeling group (p<0.001). Patients undergoing grafting had significantly less comorbidities compared to the other groups: only 1 (10%) had diabetes and none were smokers or had cardiovascular disease, p<0.001. After penile curvature correction, the mean curvature change was 25.5 for the IPP only group, 40.0 for the plication group, 55.0 for the grafting group, and 35.0 for the modeling group, p <0.001 (Figure 1). Intraoperatively, proximal perforation occurred in 2 (0.96%) patients, managed by a rear tip extender sling. Post-operatively, there were 33 (16.1%) non-infectious and 4 (1.9%) infectious complications. There was no significant difference in complications between groups.Conclusions: Although incision/excision and grafting seem to provide the greatest penile curvature correction for PD patients undergoing IPP placement, this adjunctive correction procedure is less commonly performed among high volume prosthetic urologists. Our results suggest grafting is reserved for patients with greater preoperative curvature and less preoperative comorbidities.


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