Complex Penile Surgery Plication, Grafting, and Implants

Surgical management of patients with complex PD and ED may be challenging and necessitate so-phisticated techniques for reconstruction. Although patients with severe or multiplanar cur-vature may be managed with penile plication or grafting, patients with hourglass deformity and se-vere penile shortening require penile grafting. Pa-tients with complex PD and ED generally require penile plication or grafting in conjunction with penile implant placement. In the setting of severe corporal fibrosis, placement of a penile implant may be facilitated via dilation with cavernotomes, utilization of a counter incision with or without min-imal scar tissue extraction, transcorporal scar resection, and wide scar excision with or without grafting. With extensive soft tissue defects, addi-tional tissue transfer techniques should be consid-ered to allow adequate coverage of implants and grafts.