The Peyronies Plaque Scratch: An Adjunct to Modeling

© 2013 International Society for Sexual Medicine
Surgical Techniques
The Peyronie’s Plaque “Scratch”: An Adjunct to Modeling
Paul Perito, MD* and Steven K. Wilson, MD, FACS, FRCS†
*Perito Urology, Coral Gables, FL; †Institute for Urologic Excellence, Indio, CA
Cross section of
normal penis
Normal penis wih erection
Preop showing Peyronie’s disease
Normal erect penis
without fibrous
plaque
Penis with
fibrous plaque
Cross section of penis
showing fibrous plaque in
Peyronie’s disease
FIGURE 1
Modeling (Wilson et al.) allows surgeons to correct most if not all Peyronie’s related curvatures when placing a penile prosthesis without
having to use invasive and time-consuming procedures. The accepted rate of urethral disruption from modeling is nearly 5%. To diminish
the possibility of this potential complication, the scratch procedure for internal disruption of the Peyronie’s plaque is used as an adjunct
to modeling. The procedure can also be used to rid the implanted penis of any hour-glass defects commonly found prior to implantation
in Peyronie’s patients.
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Surgical Techniques
Artificial erection injecting lidocaine/saline
Dilation of corpus cavernosum
Corpora cavernosa after dilation
Fibrous plaque in
tunica albuginea
Tunica
albuginea
corpus
cavernosum
Long nasal speculum
inserted into corporotomy
and spread laterally
Nasal speculum
Fibrous plaque
Infrapubic incision
corpora cavernosa
Corporotomy
incision
FIGURE 2
An artificial erection is accomplished in order to identify the zone of pathology and mark it externally with a pen. An 80-mm nasal
speculum is passed across the plaque and opened transversely to fracture the plaque along the x-axis.
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Surgical Techniques
Nasal speculum inserted into infrapubic incision
Fibrous plaque in
tunica albuginea
Hook-bladed knife
(BP#12)
Nasal speculum
Tunica
albuginea
corpus
cavernosum
Fibrous plaque incised
Infrapubic incision
Hook-bladed knife (BP#12) cuts
plaque while drawing knife
toward surgeon
Fibrous plaque incised
corpora cavernosa
Corporotomy
incision
FIGURE 3
A 12-blade scalpel is used to “scratch” the plaque internally along the z-axis, i.e., longitudinally. The depth of the “scratch” further disrupts
the plaque along the y-axis, completing the internal three-dimensional disruption of the plaque. An alternative to using a scalpel for the
linear incisions is using a pair of sharp Metzenbaum scissors to fracture the plaque.
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Surgical Techniques
Preop
Curvature checked after placement
of implant cylinders
After placement of
Coloplast Titan evaluate
curvature and model if
needed for curvature > 30°
Incised plaque reduces
curvature to <30° and usage
over next 8 months will
straighten further as
cylinders act as tissue
expander
Cloverleaf reservoir
Coloplast Titan
pump
FIGURE 4
Once the implant is in place, any additional modeling (Wilson et al.) may be performed. Remember to protect the urethra from distal
perforation while modeling by squeezing the fossa. Risk of urethral perforation while modeling after the “scratch” should be diminished.
The Surgical Techniques
Section is sponsored in part by
Coloplast
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