Icahn School of Medicine at The Mount Sinai Hospital
Introduction: Three piece penile prosthesis (IPP) surgery is the gold standard surgical treatment of erectile dysfunction. As this procedure is associated with penile shortening in inexperienced hands, many techniques created by experienced surgeons exist in the literature to optimize penile length and ensure proper cylinder sizing. Here we present our data on a modification of the existing tunica expansion procedure (TEP) for penile length restoration.
Methods: A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients’ charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP were analyzed. The modification entails alternating between vertical and horizontal scoring of the tunica albuginea, with vertical scoring contributing to increased penile length and horizontal scoring contributing to increased penile girth. Endpoints were average increase in prosthesis length as well as average increase in girth.
Results: A total of 23 patients from the larger cohort underwent modified TEP. All patients underwent IPP placement via scrotal approach. In patients undergoing vertical modification of TEP (n=15), average increase in length of distal corpora was 2.8cm. This was measured using Furlow before and after penile degloving with TEP. In patients undergoing horizontal TEP (n=8), average increase in girth was 1.6cm. This was measured at midphallus pre-procedure and after full inflation of prosthesis. There were no reported complications for these 23 cases.
Conclusions: In men undergoing IPP placement, modification of the already existing TEP can allow for measurable increase in penile length and girth of almost 3 and 2cm respectively. This is an important technique within the arsenal of the prosthetic urologist to ensure cosmesis post IPP placement is optimized.
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