Inflatable penile prosthesis placement in Peyronie's disease: a review of surgical considerations, approaches, and maneuvers

Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea that results in penile deformity and/or curvature. Patients usually present complaining of penile pain, shortening and deformity resulting in dissatisfaction with intercourse. Many patients with PD will present with concomitant erectile dysfunction (ED). This disease is a significant concern for patients as it impacts both sexual function and overall quality of life. While there are several interventions available for PD treatment, inflatable penile prosthesis (IPP) implantation is considered the gold standard approach for those with moderate to severe concomitant ED, refractory to medical therapy. The goal of treatment is to give a man a functionally straight erection. Placement of an IPP alone may achieve this. However, when curvature still exists, several adjunct procedures may be performed to include manual modeling, plication, plaque incision or excision and grafting. Additionally, advanced lengthening procedures may also be used. In this paper we will present a comprehensive review of the adjuvant straightening techniques that can be used during IPP placement in men with PD and refractory ED when curvature still exists. Patient selection is a key predictor of implant success, as is preoperative and postoperative management to optimize overall patient care and satisfaction. These topics along with the different surgical approaches to IPP insertion for PD will also be discussed, including the benefits and shortcomings of each. A flowchart to aid surgeons in their intraoperative decision making based on curvature characteristics and specific patient concerns is presented.