the peyronies plaque scratch: an adjunct to modelingperitourology.com/peyroniesplaquescratch.pdf ·...
TRANSCRIPT
Surgical TechniquesThe Peyronie’s Plaque “Scratch”: An Adjunct to Modeling
Paul Perito, MD* and Steven K. Wilson, MD, FACS, FRCS†
*Perito Urology, Coral Gables, FL; †Institute for Urologic Excellence, Indio, CA
FIGURE 1
Modeling (Wilson et al.) allows surgeons to correct most if not all Peyronie’s related curvatures when placing a penile prosthesis withouthaving to use invasive and time-consuming procedures. The accepted rate of urethral disruption from modeling is nearly 5%. To diminishthe possibility of this potential complication, the scratch procedure for internal disruption of the Peyronie’s plaque is used as an adjunctto modeling. The procedure can also be used to rid the implanted penis of any hour-glass defects commonly found prior to implantationin Peyronie’s patients.
Normal erect penis without fibrous
plaque
Cross section of penis showing fibrous plaque in
Peyronie’s disease
Penis with fibrous plaque
Normal penis wih erectionCross section of normal penis
Preop showing Peyronie’s disease
© 2013 International Society for Sexual Medicine
1194 J Sex Med 2013;10:1194–1197
Surgical Techniques
FIGURE 2
An artificial erection is accomplished in order to identify the zone of pathology and mark it externally with a pen. An 80-mm nasalspeculum is passed across the plaque and opened transversely to fracture the plaque along the x-axis.
Long nasal speculum inserted into corporotomy
and spread laterallyNasal speculum
Artificial erection injecting lidocaine/saline
Dilation of corpus cavernosum
Corpora cavernosa after dilation
Fibrous plaque
Fibrous plaque in tunica albuginea
Corporotomy incision
corpora cavernosa
corpus cavernosum
Tunica albuginea
Infrapubic incision
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Surgical Techniques
FIGURE 3
A 12-blade scalpel is used to “scratch” the plaque internally along the z-axis, i.e., longitudinally. The depth of the “scratch” further disruptsthe plaque along the y-axis, completing the internal three-dimensional disruption of the plaque. An alternative to using a scalpel for thelinear incisions is using a pair of sharp Metzenbaum scissors to fracture the plaque.
Hook-bladed knife (BP#12) cuts plaque while drawing knife
toward surgeon
Nasal speculum inserted into infrapubic incision
Fibrous plaque incised
Infrapubic incision
Nasal speculum
Hook-bladed knife (BP#12)
Fibrous plaque in tunica albuginea
corpus cavernosum
Tunica albuginea
Fibrous plaque incised
Corporotomy incision
corpora cavernosa
1196 J Sex Med 2013;10:1194–1197
Surgical Techniques
FIGURE 4
Once the implant is in place, any additional modeling (Wilson et al.) may be performed. Remember to protect the urethra from distalperforation while modeling by squeezing the fossa. Risk of urethral perforation while modeling after the “scratch” should be diminished.
The Surgical TechniquesSection is sponsored in part byColoplast
Incised plaque reduces curvature to <30° and usage
over next 8 months will straighten further as
cylinders act as tissue expander
Curvature checked after placement of implant cylinders
Preop
Coloplast Titan pump
Cloverleaf reservoir
After placement of Coloplast Titan evaluate curvature and model if
needed for curvature > 30°
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