Treating Peyronie's Disease with an implant and a new Cavernotome

[Lost Sheep]

Treating Peyronie's disease with an implant often requires dealing with a lot of scar tissue that limits the surgeon's options. This technique suggests a new tool and technique.

https://www.academia.edu/20799226/A_NEW ... o=download

IMPLANTATION OF INFLATABLE PENILE PROSTHESIS IN PATIENTSWITH SEVERE CORPOREAL FIBROSIS: INTRODUCTION OF A NEWPENILE CAVERNOTOME
MICHAEL MOOREVILLE,*,†,‡ SORIN ADRIAN,* JOHN R. DELK, II
AND
STEVEN K. WILSON§
From the Mercy Medical Center, Thomas Jefferson University Hospital and Drexel University, Philadelphia, Pennsylvania, and Southwest Impotency Center, Van Buren, Arizona
ABSTRACT
Purpose:
Implantation of penile prosthetic cylinders into scarred corpora remains a challengein the field of prosthetic urology. We describe a new penile cavernotome, which allows for easierdilation of fibrotic corpora cavernosa and facilitates inflatable penile prosthesis cylinder inser-tion.

Materials and Methods:
A set of 5 cavernotomes between 6 and 13 mm. in diameter are used to drill a space in fibrotic corpora with controlled 1 mm. cuts. The cavernotomes are advanced inan oscillating fashion and also allow shaving of severely stenotic areas for easier cavity devel-opment. They were used in 16 patients with fibrotic corpora secondary to different etiologies. A high transverse scrotal incision was used in all cases. Of the 16 patients 14 received downsizedcylinders.

Results:
Implantation of both cylinders of an inflatable 3-piece device was successful in allcases. Proximal crural perforation occurred intraoperatively in 5 patients and was corrected byattaching the rear tip extender to the tunica with nonabsorbable suture. Postoperatively, distaltunical perforation of the corpora in 4 patients was repaired with natural tissue. Operative time was reduced compared to our previous experience with implantation in cases of corporeal fibrosisusing extensive corporotomies or the Carrion-Rossello cavernotomes. In no case was the proce-dure terminated for urethral laceration or inadequate dilation for cylinder insertion. No grafting materials were necessary to close the corporotomy.

Conclusions:
The new cavernotomes along with the high transverse scrotal incision anddownsized prostheses resulted in successful implantation in all of our cases. Dilation of fibroticcorpora was easier and quicker with the new cavernotomes because extensive corporeal resectionwas not necessary. Complications were acceptable for these difficult cases and prosthesis sur- vival is 100% to date.

[Waynetho]

Were that this was known and available to my doctor on 10/28 when he "ran into issues" and gave my 5" stretch measurement a 15cm (5.9") implant with no RTEs (read: just around 1" proximal depth).