Implant surgery in Peyronie's disease

Biomechanical aspects of Peyronie's disease in development stages and following reconstructive surgeries

Peyronie's disease is a disorder of the penile connective tissues that leads to development of dense fibrous or ossified plaques in the tunica albuginea, causing penile deformity and painful erection. A biomechanical model of the penis was utilized for analyzing the mechanical stresses that develop within its soft tissues during erection in the presence of Peyronie's plaques. The model's simulations demonstrated stress concentrations around nerve roots and blood vessels due to the plaques. These stresses may irritate nerve endings or compress the vascular bed, and thus cause penile deformity and/or painful erection. The model was further used to elaborate the effects of different biological or artificial materials for reconstruction of the penis following plaque removal. Clinical applications of the present model can range from analysis of the etiology of the disease to assisting in the determination of optimal timing for therapeutic interventions and in the selection of patch material for penile reconstructions.

[When and why to use penile prostheses: seven years of experience]

During the last years important changes in the management of the patients with erectile dysfunction have been verified. Psychologist, neuro-physiologist and bioengineers have given a valuable help in this field. Implant surgery represents, to our notice, the curative more acceptable choice for patient and the partner, since the results are excellent and the materials used extremely manageable. In each case the degree of satisfaction of the patient remains the only legitimate indicator currently for establish the effectiveness of the therapy.

Computational tools in rehabilitation of erectile dysfunction

Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection adequate for satisfactory intercourse. It is a common problem among approximately 50% of men between the ages of 40 and 70. Erectile dysfunction is not only stressful to both the affected individual and his partner, but it can also negatively affect self-esteem. Biomechanical models have recently been developed to study both the structural and hemodynamic factors involved in normal and pathological erectile conditions. These computational models, which are reviewed in the present paper, allow for better understanding of the mechanisms acting in ED and provide a suitable basis for development of state-of-the-art interdisciplinary treatment approaches aimed to improve the quality of life for these men.

A biomechanical model of Peyronie's disease

Peyronie's disease is a pathological condition of the penis which is characterized by localized ossification of the tunica albuginea. A common symptom of the chronic stage is penile deformity during erection, which is frequently associated with pain and erectile dysfunction. A two-dimensional biomechanical model of the penis was applied to study the development of Peyronie's disease by simulating the mechanical stress distribution which would result from the interaction of the ossified tunical tissue with other penile soft tissues. The model was solved by using commercial finite element software for a characteristic erectile pressure. The results demonstrate that Peyronie's plaques may induce intensified stresses around the penile nerves and blood vessels, up to double those in the normal penis. These elevated stresses may cause a painful sensation of neural origin or ischemia in regions of compressed vascular tissue. Severe penile deformities have been shown to develop if Peyronie's plaques develop only around one of the corpora cavernosa due to the non-homogeneous resistance of the tunica to expansion during erection. The present model can be clinically applied as an aid in the planning process of reconstructive surgery or insertion of a prosthesis.