Peyronie’s Disease: Tunical String-vest Incisions for Girth and Length Restoration after Penile Prosthesis Implantation

Giulio Garaffa, Marco Capece, Giovanni Chiriaco and David Ralph

Peyronie’s Disease, penile prosthesis, girth and length restoration

A variety of techniques of simultaneous girth and length restoration and penile prosthesis implantation are available for patients with Peyronie’s Disease (PD). Meshing incisions have been widely used in plastic surgery to expand the surface of tissues and this principle can be applicable to the tunica albuginea.

This is the case of a 62 year-old patient with end stage erectile dysfunction, complex deformity and significant loss of length secondary to PD who has undergone simultaneous girth and length restoration with tunical string-vest incisions and implantation of a three pieces inflatable penile prosthesis.

Once the penile shaft has been degloved through a subcoronal incision, the urethra and the neurovascular bundle are dissected off the corpora cavernosa through two para-urethral incisions of Buck’s fascia. A three pieces inflatable penile prosthesis is then inserted though the same approach and a 125 cc reservoir has been placed ectopically. The cylinders have been intentionally upsized of 2 cm from the original corporal measurements. The tunica albuginea is then expanded in girth and length performing multiple small incisions in a mesh pattern until satisfactory curvature correction is achieved and adequate girth and length are restored.  As all tunical incisions were less than 1 cm in length, the risk of aneurysm of the cylinders was minimal and therefore grafting of the defect was not necessary.

Postoperative time has been uneventful. Six months postoperatively the patient is able to engage in penetrative sexual intercourse and is fully satisfied with the outcome of surgery.

A variety of techniques of simultaneous penile girth and length restoration and penile prosthesis implantation in patients with PD have been described. In order to avoid aneurysmal dilatation of the cylinders, defects in the tunica albuginea larger than 1 cm should be grafted, but this is a time consuming manoeuvre. String-vest incisions of the tunica albuginea instead guarantees adequate tissue expansion and avoids the need for grafting as the defects are too small to cause aneurysmal dilatation of the cylinders.

1. Rolle L, Falcone M, Ceruti C, Timpano M, Sedigh O, Ralph DJ, Kuehhas F, Oderda M, Preto M, Sibona M, Gillo A, Garaffa G, Gontero P, Frea B.
   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 May;117(5):814-20.
2. Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S,  Hakim L, Sadeghi-Nejad H, Broderick G.
   Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med. 2016 Jun; 13 (6) :905-23.
3. Sansalone S, Garaffa G, Djinovic R, Egydio P, Vespasiani G, Miano R, Loreto C, Ralph DJ.
   Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie's disease, refractory erectile dysfunction, and severe penile shortening. J Sex Med. 2012 Jan;9(1):316-21