Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

3D-Printed Flexible Penile Model Simulator for Plaque Incision and Graft for Peyronie's Disease

Introduction

Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie's disease (PD), but most surgeons perform very few PIG surgeries annually, and the number of PD cases requiring PIG is inadequate to maintain the necessary skills and completely master the procedure.

Aim

To develop and validate a new 3D-printed model of a curved penis and graft to simulate PIG surgery. This is the first PIG surgical training simulator described in the medical literature.

Methods

A 3D-printed model of the corpora cavernosa with a 60-degree curvature and an associated urethra was created using a flexible filament of thermoplastic polyurethane. Twenty-two urologists from Brazil were recruited to perform simulated surgery on the 3D model. The participants included 12 senior-level and 10 trainee-level urologists.

Main outcome measures

Evaluation of the device was based on a 15-item questionnaire using a 5-point Likert-type scale for each item.

Results

Each participant performed one simulated surgery with the 3D-printed model. All participants agreed that the simulation should be implemented into training programs. Participants ranked all content validity components ≥4.41 and all face validity components ≥3.83. The mean usability score was 4.25, and the overall experience scores were 4.75 (senior) and 5.0 (trainee).

Conclusion

Senior and trainee urologists evaluated this first reported simulated PIG training model for penile curvature correction as an acceptable tool for training and maintaining necessary PIG skills. This model may improve PIG training and surgeon skill, thereby improving patient safety and outcomes.

A Miranda. 3D-Printed Flexible Penile Model Simulator for Plaque Incision and Graft for Peyronie's Disease. Sex Med 2021;9:100318.

Surgical Planning and Strategies for Peyronie's Disease

INTRODUCTION

Peyronie's disease results in penile curvature, shortening, instability, or pain upon erection-hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment.

OBJECTIVE

To present an organized description of the most common surgical techniques used in the correction of Peyronie's disease and to propose a surgical algorithm to guide management.

METHODS

Using PubMed, we reviewed the published literature regarding surgical treatment of Peyronie's disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes.

RESULTS

Peyronie's disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management.

CONCLUSION

Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of "borderline" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie's disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important. Almeida JL, Felício J, Martins FE. Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2021;9:478-487.

Contemporary surgical and non-surgical management of Peyronie's disease

Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.