Malleable Penile Prosthesis combined with the multiple incision technique in the management of severe Peyronie’s disease

V. Lima, V Santos, N.Oliveira, V. Favaro, S. Duraes, T. Mierzwa

Introduction:

Peyronie’s disease is a fibrotic disorder of the tunica albuginea that may lead to significant penile curvature, shortening, and erectile dysfunction. Surgical correction is recommended in stable, severe cases, especially when curvature exceeds 60 degrees or is associated with functional impairment.

Case Presentation:

A 56-year-old male with a history of hypertension, type 2 diabetes mellitus, cardiac arrhythmia, and hypothyroidism presented with dorsal penile curvature for over one year. He reported progressive erectile dysfunction, difficulty with penetrative intercourse, and perceived penile shortening. Physical examination revealed a firm penile shaft with

multiple fibrotic plaques and a stretched flaccid length of 10 cm. The patient had not received prior treatment.

Surgical Technique:

After antiseptic preparation with 2% chlorhexidine, an artificial erection with 0.9% saline confirmed a dorsal curvature of approximately 70 degrees. A subcoronal circumferential incision and complete penile degloving were performed. The dorsal neurovascular bundle and dorsal vein were carefully dissected and mobilized. A dense posterior plaque was identified and multiple dorsal incisions (spaced 2–3 mm apart) were made using a cold blade to release fibrotic tension and promote shaft lengthening. After serial dilations and sizing, a malleable penile prosthesis was implanted. Closure was performed in three layers with 3-0 Vicryl and 4-0 Monocryl for the skin. A compressive dressing was applied to prevent hematoma formation.

Conclusion:

The use of multiple dorsal incisions proved to be an effective technique for correcting complex penile curvatures greater than 60 degrees. When combined with penile prosthesis implantation, this approach can successfully restore penile length and function in patients with severe fibrotic Peyronie’s disease.