Peyronie’s disease or “crooked penis” is a condition that can result in bending of the erect penis, painful erections and erectile dysfunction.  This condition often remains mild, but occasionally, Peyronie’s disease can progress to the point that it interferes with your sex life.  

Peyronie’s disease produces hard plaques that are deposited on the corpora cavernosa of the penis.  The corpora cavernosa are two cylinders that run the full length of the penis and they fill with blood during the erection. The corpora are responsible for the erection.

The exact cause of Peyronie’s disease is unknown. One theory is that the penile plaques are the result of abnormal wound healing in response to mild trauma to the penis. 

The search for the cure to Peynronie’s disease has been a long and frustrating process. Recently, however, there have been some very exciting breakthroughs in both the medical and surgical treatment of this disease. 

Peyronie’s Disease and Erectile Dysfunction

If you have Peyronie’s disease and erectile dysfunction, the first step is to try Viagra or Cialis.  If the pills do not work, then the next step is to try penile self- injection therapy with Prostaglandin E1. If these two conservative therapies do not work, the final step is the penile implant. The penile implant is by far the most effective treatment of ED due to Peyronie’s disease.

Results of Penile Implant for Peyronie’s Disease

The penile implant accomplishes two things – it restores penile rigidity and it helps to straighten bending of the penis.  Patient satisfaction with the penile implant is high and approaches 86% is some studies.  

Complications of the penile implant procedure include device infection, device erosion and mechanical failure. The most frequent complaint, among patients who receive the implant, is that the erect penis is not as long as the patient would like.

Penile Implant Combined with the Modelling Procedure

Some patients with Peyronie’s disease have erectile dysfunction and severe bending of the penis.  Insertion of the penile implant alone may not always straighten out the penis. In these patients, the modelling procedure can be performed in combination with the penile implant.

The modelling procedure helps to straighten the penis.  It accomplishes this by applying mechanical force directly to the penis. This force disrupts the hard plaques that are responsible for bending of the penis.

During the first step of the procedure, Dr. .Lazare inserts the penile implant in the standard fashion.  The penile implant is then inflated. Dr. Lazare then forcefully bends the penis in the direction opposite to the bend.  This maneuver disrupts the plaques and helps to straighten the penis. 

The modelling technique sounds nasty, but it is effective.  Successful outcomes occur in over 86% of the patients. The main risk of the modelling procedure is injury to the urethra.  If urethral injury occurs, the implant must be removed and the procedure is aborted. Urethral injury occurs in about 4 % of patients [1]. 

Penile Implant with Plaque Incision and Grafting – “PICS” Procedure 

The PICS procedure stands for Penile Implant in Combination with the Sealing Technique.  It is a new and exciting procedure for patients with Peyronie’s disease who suffer from ED and penile deflection. 

During the first step of the PICS procedure, Dr. Lazare inserts the penile implant.  Next he incises the penile plaques. Finally, he places a graft over the defect created by graft incision.

Treating Peyronie’s plaques with incision and grafting is nothing new.  What makes this procedure special is the new graft material that it uses. The new graft material is called TachoSil and it consists of equine – horse derived – protein called collagen and the human clotting proteins – fibrinogen and thrombin. 

The advantage of TachoSil is that it sticks to the wound and does not need to be sewn in place.  The problem with suturing a grafts over a penile implant is that the needle can damage the implant.  TachoSil avoids this risk. In addition, because TachoSil does not require suturing, it can be applied quickly, and this saves time in the operating room.

Results and Advantage of the PICS Procedure

Initial results of the PICS procedure have been excellent in terms of restoring erectile functioning and straightening the penis [2].

The PICS procedure has several advantages over the modelling procedure. 

First, the PICS procedure rarely causes damage to the urethra.  Remember, if the urethra is damaged, the entire procedure must be aborted.

The second advantage of the PICS procedure is that it often results in lengthening of the erect penis.  When the plaque is incised over the inflated implant, an audible pop is heard as the penis expands. The penis typically gains 2.5 cm in length as a result of the PICS procedure [3].   

Finally, the PICS technique is uniquely suited to those patient who have complex deformities including penile indentation and the penile hourglass deformity.

Is TachoSil the Ideal Graft Material?

An ideal graft should have several properties. It should be inexpensive and readily available.  It should not produce an infection and it should not produce an immune response. It should be fast and easy to apply. Finally, it should allow for the ingrowth of blood vessels. TachoSil seems to fulfill many of the ideal graft requirements. Although it is relatively new, early results suggest that TachoSil represents an exciting advance in graft technology.

Hope for Patients with Severe Peyronie’s Disease

Patients with the most severe forms of Peyronie’s disease now have excellent new surgical options available to them. Even the most severe cases of this condition can be treated, and the results are often excellent.

Footnotes

[1] Wilson, SK, Cleves, MA, Delk, JR, Long Term Follow-up of Treatment for Peryronie’s Disease, Modeling the Penis Over an Inflatable Penile Prosthesis, The Journal of Urology, Vol. 165, 825-829, March 2001

[2] Hatzichristodoulou, G, The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie’s Disease Using the Collagen Fleece TachoSil, The Journal of Sexual Medicine, 2018, 15, 416-421

[3] Fernandez-Pascual, E, Gonazalez-Garcia, F, Rodriguez-Monsalve, M, Turo, J, Marinez-Ballesteros, C, Carballido, J, Marinez-Salamanca, J, Surgical Technique for Complex Cases of Peyronie’s Disease With Implantation of Penile Prosthesis, Multiple Corporal Incisions, and Grafting with, Collagen Fleece, The Journal of Sexual Medicine, 2019, 16, 323-332