Surgical Correction After Manual Modeling Fails in Stable Peyronie's Disease with Erectile Dysfunction Refractory to Pharmacotherapy
Clinical Scenario
This protocol addresses patients with stable Peyronie's disease and concurrent erectile dysfunction that has not responded to pharmacotherapy — including PDE5 inhibitors and intracavernous injections of vasoactive agents — and in whom a prior penile straightening manoeuvre has left residual curvature that still compromises sexual function.
Previous Step Did Not Achieve the Target
Manual modeling of the penis with the prosthesis maximally inflated was performed. The goal was to reduce residual penile curvature to less than 30 degrees. When that target is not reached after this manoeuvre, a further corrective step is indicated and this protocol defines what comes next.
Next Surgical Approach — Partial Overview
When curvature remains beyond the acceptable threshold, a surgical intervention targeting the penile curvature is performed. The complete protocol specifies which technique applies, how the decision is made, and what criteria guide the approach. The clinical goal is functional penile straightening to allow penetrative intercourse.
References
- Use penile prosthesis implantation, with or without any additional straightening procedures (modelling, plication, incision or excision with or without grafting), in PD patients with ED not responding to pharmacotherapy.
- Penile prosthesis implantation is typically reserved for the treatment of PD in patients with concomitant ED not responding to conventional medical therapy (PDE5I or intracavernous injections of vasoactive agents).
- Perform surgery only when Peyronie's disease (PD) is stable and sexual intercourse is compromised due to the deformity.
- If a deviation > 30° persists after performing this manoeuvre, correction should be performed through shortening or lengthening procedures (incision with or without grafting).
- The aim of surgery is to correct curvature and allow penetrative intercourse.
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