Penile Prosthesis ImplantationPenile prosthesis implantation are indicated in patients with Peyronie’s disease and Erectile Dysfunction that do not response to conservative treatment. In particular patients with severe deformities undergo simultaneously to penile prosthesis implantation and penile reconstruction of length, girth and shape.
The maximum restoration of the length is limited by the length of dissected Neurovascular bundle (NVB). Two or three pieces of inflatable or malleable penile prosthesis are implanted. Three component prostheses are the most sophisticated and consist of two cylinders that are implanted into the corpora cavernosa. The pump and the reservoir are independent, the pump device is placed in the scrotum and the reservoir in the Retzius space. The advantage of this devices lays in the possibility to achieve a complete flaccidity and more natural erection.
The patients with mild or no curvature, with significant penile shortening, due to diffuse tunical elasticity damage, should undergo reconstruction by complete circular incision and transversal grafting. Gain in penile size in these cases is limited by the length of the NVB, as the urethra, composed by spongiosal tissue, stretches easily. Two complete circular incisions on two different levels are belive to be better than one, in order to avoid overstretching of cavernosal tissue, which occurs if only one circular incision is used. For isolated narrowing of corpora cavernosa, without any other deformity, for girth enhancement two long lateral grafts are used.