(100) AUXETIC TECHNIQUE APPLICATION DURING PENILE PROSTHESIS IMPLANTATION TO CORRECT DEFORMITIES IN PEYRONIE’S DISEASE: A CASE SERIES
Authors: Miranda A 
Published: December 2024

Abstract

Introduction
Peyronie’s disease (PD) is characterized by a series of penile deformities including curvature, narrowing, and shortening, which are commonly associated with a reduction in both penile length and girth. Additionally, 43.5% of patients with this condition experience erectile dysfunction (ED), for which penile prosthesis implantation (PPI) is the recommended treatment. Recently, a new surgical treatment approach for correcting penile deformities has been published (Auxetic technique). This innovative method has the capability to correct any penile deformity, restoring both the length and girth of the penis without the need for grafting.

Objective
The objective of this study is to describe the initial application of the Auxetic technique in 16 cases of PD associated with ED.

Methods
From November 2019 to September 2023, 16 consecutive patients with PD associated with ED, with a mean age of 59 years (47 to 71 years), were enrolled in this study. They were submitted to penile prosthesis implantation after tunica albuginea incision using a new auxetic guide device to generate the standardized star shape incision on the corpora cavernosa. The incisions create a rotating triangles system, which generates the tunica albuginea expansion in two dimensions (longitudinal and transversal), resulting in tissue increasement, correcting the penile deformity [fig. 1]. During the surgery, measurements of penile length and girth, curvature degree, and the presence of hourglass deformity were recorded. At the conclusion of the procedure, the penis was reevaluated to confirm whether the deformity had been completely corrected. Additionally, intraoperative and postoperative complications were documented and classified using the Clavien-Dindo grading system. Postoperative patient satisfaction was also assessed.

Results
Among the 16 patients who underwent surgery, 8 presented with uniplanar penile curvatures, 8 with multiplanar curvatures, and 7 exhibited hourglass deformities. In multiplanar cases, curvature angles ranged from 40 to 110o across each plane. In uniplanar cases, the mean curvature angle was 74.3o, with a range from 60 to 90o. The mean reduction in penile circumference at hourglass deformity point was 1.2 cm, and the average subjective penile length loss was 2.6 cm. The average operative time was 134 minutes. No major intraoperative complications were observed. 6 patients received inflatable penile implants while 11 received malleable penile prostheses. Postoperatively, a total of 2 patients experienced complications: 1 was classified as Clavien-Dindo grade I, and one patient was classified as grade IIIa, requiring surgical correction for paraphimosis. Patients were discharged after 24–48 hours. The average increase in penile length was 1.8 cm, and girth expanded by 1.2 cm following the implantation of inflatable penile prostheses. Additionally, all penile deformities were successfully corrected after the auxetic incisions. No other complications were noted after a mean follow-up period of 22,8 months (6 to 52 months). 13 patients were very satisfied and 3 were moderated satisfied with the result and all of them would undergo the surgery again.

Conclusions
The results of this study demonstrate that the auxetic technique effectively corrected penile curvature and other deformities, restoring both penile length and girth during penile prostheses implantation.

Disclosure
No.