Modified Auxetic Tunical Expansion (MATE): A versatile approach for Peyronie’s deformity correction during penile prosthesis implantation

M. Lindenbaum, B. Berk, P. Oh, A. Miranda, P. Bajic

Auxetic; Peyronie’s; Incision and grafting; Inflatable penile prosthesis.

Introduction:

Peyronie’s disease (PD) is a common condition which can cause penile deformity including curvature,  loss of length and loss of girth.  Many men with PD also have erectile dysfunction refractory to conservative therapy and often require inflatable penile prosthesis (IPP) implantation with concurrent straightening maneuvers.

Severe curvature with associated girth loss, in the setting of bothersome length loss, may be treated with plaque incision or partial excision and grafting at the time of IPP. However, large tunical defects covered with non-sutured collagen fleece grafts can lead to cylinder herniation or extrusion.

Several techniques using multiple small incisions have been proposed. These relaxing incisions release tethering in one axis while simultaneously causing narrowing in the perpendicular axis which limit deformity correction.

In 2022, Miranda et al described auxetic incisions which use a series of small 3-pointed star shaped incisions to provide expansion in both axes simultaneously. Our modified technique uses auxetic incisions and combines them with collagen fleece grafting to provide hemostatic and structural Support.

Methods:

In the video we show the surgical technique of a modified auxetic tunical expansion, in a patient who was undergoing an IPP placement

Results:

The patient had a successful auxetic tunical inicision with collagen fleece grafting. He had an uneventful postoperative course. He had a gain of 1.5cm in penile length, full correction of PD curvature and was overall satisfied with the results.

Conclusions:

Auxetic tunical incisions with collagen fleece grafting is a feasible and safe technique for PD patients undergoing penile prosthesis implantation with concurrent straightening maneuvers.  This technique has the potential to change the current paradigm for penile length and girth optimization during IPP implantation in PD patients