Scrotal Tunica Expansion Procedure (TEP): A Single-Incision Technique for Penile Length Restoration and Prosthesis Implantation in Peyronie’s Disease

R. J. Valenzuela, B. Tran, F. Saverio-Rodriguez

Penile prosthesis, Tunica Expansion, Peyronie's disease

Introduction: Penile shortening, curvature, and erectile dysfunction in Peyronie’s disease significantly affects quality of life and sexual function. Traditional surgical options involving grafting are associated with increased morbidity and longer recovery. The Scrotal Tunica Expansion Procedure (TEP), is a novel single-incision technique that combines tunical expansion and inflatable penile prosthesis (IPP) implantation, eliminating the need for subcoronal degloving and reducing surgical complexity.

Objectives: To describe the Scrotal Tunica Expansion Procedure (TEP), a single-incision technique that enables simultaneous penile length and girth restoration, curvature correction, and inflatable penile prosthesis (IPP) implantation in patients with Peyronie’s disease while avoiding grafting, subcoronal degloving, and minimizing surgical morbidity.

Methods: Under general anesthesia, a vertical midline scrotal incision was made and extended to the penoscrotal junction. The urethra was mobilized laterally, and the corpora were exposed bilaterally without injuring Buck’s fascia or the neurovascular bundle (NVB). Initial corporal measurements were obtained using a Furlow instrument.

The penis was degloved and everted, Buck’s fascia was mobilized dorsally. The NVB was carefully dissected to allow access to the dorsal tunica. Multiple tunical relaxing incisions were created to achieve uniform tunical expansion for length and girth restoration without grafting. Post-expansion length was remeasured.

After controlled dilation, a three-piece inflatable penile prosthesis (IPP) was implanted using a corporal-sparing technique. Modeling was performed to optimize cylinder expansion. The reservoir was placed in the space of Retzius and the pump in a dependent scrotal pouch. All components were connected and tested. A Jackson-Pratt drain was placed, and layered closure was completed. The prosthesis was left partially inflated.

Results: This technique has demonstrated an average penile length gain of 2.5–4.0 cm. Curvature is corrected intraoperatively, and no grafts are required. Patients experience improved length, girth, and erectile function with low complication rates. The single scrotal incision reduces operative time and morbidity compared to circumcision and penile degloving for dorsal plaque incision and grafting with penile prosthesis.

Conclusions: Penoscrotal TEP is a safe, effective, and minimally invasive alternative for patients with Peyronie’s disease, erectile dysfunction and loss of penile length and girth requiring IPP and correction of angulation. By eliminating the need for grafting and utilizing a single incision, this technique improves penile dimensions, restores function, and simplifies surgical management while minimizing complications.

None.

The authors have nothing to disclose