Extended corporal dilation decreases the need for intraoperative adjuvant maneuvers for residual curvature after inflatable penile implant placement in men with Peyronie’s disease

Abstract Background Residual penile curvature after inflatable penile prosthesis (IPP) placement is a recognized problem, which may require adjuvant procedures to achieve complete curvature correction. Aim To evaluate the impact of extended corporal dilation (ECD) on the magnitude of intraoperative residual curvature and the need for adjuvant maneuvers during IPP placement in men with Peyronie’s disease (PD). Methods Men with PD who had a penile duplex Doppler ultrasound/curvature assessment and goniometer assessment of deformity magnitude who underwent penile implant surgery constituted the study population. Prior to 2016, corporal standard dilation (SD) with a Dilamezinsert dilator was conducted. Since then, we have incorporated ECD, adding the use of serial Hegar dilation ≥14 mm. After device insertion and full inflation, repeat goniometer assessment of residual curvature was performed. If 20° of curvature remained, adjuvant maneuvers were performed. We compared residual curvature rates and the need for adjuvant intraoperative maneuvers between the SD and ECD groups. Outcomes The primary outcome was the degree of residual intraoperative curvature and secondarily the need for performing adjuvant maneuvers. Results Two hundred eighty-four men met all criteria, with a mean age = 63 ± 22 years. Two hundred eighteen (77%) patients underwent SD, while 66 (23%) had ECD. Baseline and residual curvature for the entire cohort was 62 ± 12° and 24 ± 22°, respectively. Despite similar baseline magnitude of penile curvature (P = .76), ECD resulted in less post-implant intraoperative residual curvature (P = .02) and less need for intraoperative adjuvant maneuvers (P .01). One patient in each group had an intraoperative urethral perforation during manual modeling (SD 1%, ECD 1.5%; P .05). Clinical Implications ECD provides a more effective strategy for reducing intraoperative curvature correction and the resulting need for adjuvant maneuvers during IPP placement in men with PD. Strengths and Limitations Strengths include standardized preoperative and intraoperative curvature assessment and direct comparison of two dilation strategies; limitations include retrospective design, single-center data, and modest sample size for the ECD cohort. Conclusion ECD during IPP surgery in PD reduces residual intraoperative curvature and the requirement for adjuvant maneuvers. While further evaluation is necessary, these preliminary data may support its eventual adoption as a technique.