Surgical Management of Ossified Peyronie’s Disease: Pericardium Graft and Malleable Penile Prosthesis Implantation

A. di Giovanni, A. Gobbo, D. Ralph, D. Lee

Peyronie's disease, malleable prosthesis, pericardium patch, erectile dysfunction, ossified plaque

Introduction:

Peyronie's disease (PD) is a connective tissue disorder characterized by fibrous plaques within the tunica albuginea, leading to penile deformities and erectile dysfunction (ED). In advanced cases, plaques may ossify, complicating surgical management. Penile prosthesis implantation is a standard treatment for ED in PD patients, but ossified plaques present unique technical challenges.

Objectives:

To demonstrate the surgical technique and outcomes of malleable penile prosthesis implantation in a patient with an ossified plaque due to PD, including plaque excision and reconstruction using a pericardium graft.

Methods:

A 45-year-old male with PD and ED presented with an ossified plaque causing 60 degree dorsal curvature and chronic penile pain. Surgery involved a degloving approach to access the tunica albuginea through the neurovascular bundle. The ossified plaque was excised, and a pericardium graft was used to cover the defect and reconstruct the septum between the corpora cavernosa. The dorsal vein was sacrificed to facilitate closure of the neurovascular bundle. A malleable penile prosthesis was then implanted.

Results:

The procedure was completed without intraoperative complications. Postoperative imaging confirmed correct positioning of the prosthesis. At 1 year follow-up, the patient reported satisfactory erectile function with adequate rigidity for penetrative intercourse. There were no signs of infection, extrusion, or mechanical failure.

Conclusions:

Malleable penile prosthesis implantation with ossified plaque excision and pericardium graft reconstruction is a safe and effective approach for managing ED in patients with PD. This technique allows for plaque removal, reconstruction of the tunica and septum, and successful prosthesis implantation while minimizing complications. Further studies are warranted to assess long-term outcomes in this patient population.

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