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

J Sex Med 2013;10:1194–1197 1195

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°

J Sex Med 2013;10:1194–1197 1197