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Penile Length Restoration at the Time of Inflatable Penile Prosthesis Insertion

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UroLift® System Treatment: Expert Panel Discussion with Dr. Valenzuela

The UroLift® System treatment for BPH entered the US urologist’s armamentarium in September 2013 upon FDA clearance. With the issuance of Category 1 CPT coding January 1, 2015, we expect this procedure to become widely adopted. Dr. Valenzuela joined a panel of urologists with direct experience to discuss key aspects of this new procedure that could be helpful to those preparing to bring the UroLift System treatment into their practices.

Urology Times, January 2015

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The Modified Sliding Technique (MoST) for Penile Lengthening with penile prosthesis insertion 

Penile curvature caused by Peyronie’s disease (PD) and the subsequent difficulty with penetration and shortened stretched penile length (SPL) are extremely distressing to men. While standard incision and plication or modeling may work for small abnormalities, grafts are the preferred method for correcting large deviations or multiple abnormalities. Both techniques often shorten the SPL. Mobilization of the neurovascular bundle (NVB) has been described to maintain length during PD treatment, but this is often only temporary. Following inflatable penile prosthesis placement (IPP), NVB can be mobilized and PD treated as the IPP acts as a scaffold for penile reconstruction. We describe our experience in correcting PD and lengthening following NVB mobilization followed by IPP placement, using a subcoronal incision. 

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Penile Curvature Secondary to Peyronie’s Disease with Penile Prothesis and Relaxing Incisions without Loss of Length

Erectile dysfunction (ED) treated with an inflatable penile prosthesis (IPP) and Peyronie’s disease (PD) managed by incision and plication both are thought to decrease penile length postoperatively. Pathologically the tunica scarring or fibrosis of this disease severely limits the elasticity of the tunica albuginea. Even high volume implanters have noted that they often identify undiagnosed PD during IPP placement. In most cases the deviations are not treated because surgeons are concerned about damaging the prosthesis. A subcoronal incision for PII placement allows access to the entire corporal shaft for correction of penile angulation, incision of plaques in PD and other penile reconstructive procedures.

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Glans Fixation for Floating Glans (SST Deformity) During Penile Prosthesis Placement without additional Incisions

Supersonic transporter (SST) deformity is a known complication following inflatable prothesis (IPP) surgery and occurs when the glans penis does not assume its normal anatomic position atop the penile shaft after their partners. SST deformity may lead to buckling of the glans and therefore poor ability to penetrate during intercourse, causing dissatisfaction for men and their partners. The hypermobile glans requires realignment and glanulopexy may correct the issue by fixing the glans to the shaft, avoiding the buckling that will otherwise occur during penetration. This repair, provides both ventral and lateral fixation to allow the glans to be evenly reapproximated onto the corporal bodies providing a more natural fix. We have adapted this technique of glanulopexy following subcoronal placement of the prosthesis.

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Subcoronal Exposure Technique Through a Modified No Touch Technique for Penile Reconstructive Survey

The surgical treatment for disorders of male sexual function requires specific exposure to safely and efficiently correct the underlying problem. Subcoronal exposure is utilized for treatment of phimosis, Peyronie’s plaque and semi-rigid penile prosthesis insertion. Infrapublic or scrotal incisions are used for inflatable penile prosthesis (IPP) placement. Men who present with several disorders may require procedures and surgical incisions. A single subcoronal incision allows for access to the entire corporal shaft for reconstructive procedures.

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Simultaneous Inflatable Penile Prosthesis and Quadratic Transobturator Male Sling Procedure

Following radical prostatectomy (RP), the development of stress urinary incontinence (SUI) and erectile dysfunction (ED) are known complications. After medical treatment fails, inflatable penile prosthesis (IPP) and transobturator male sling are validated surgical options. 

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Inflatable Penile Prosthesis After Quadratic Transobturator Male Sling Procedure

Following radical prostatectomy (RP), the development of stress urinary incontinence (SUI) and erectile dysfunction (ED) are known complications. After medical treatment fails, inflatable penile prosthesis (IPP) and transobturator male sling are validated surgical options. 

Aaron C Weinberg MD, Christopher M Deibert MD, MPH, Kelvyn Hernandez MD, Paulo H Egydio MD, PhD, Robert J Valenzuela MD

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Current strategies for maintaining penile size following penile implant

Insertion of a penile prosthesis is typically reserved as the last line of treatment for drug-refractory erectile dysfunction (ED). Loss of penile length as a result of penile prosthesis placement is the most common postoperative patient complaint shown to reduce overall satisfaction with the procedure. 

Lee KCJ, Brock GB. Strategies for maintaining penile size following penile implant. 
Transl Androl Urol 2013;2(1):67-73. doi: 10.3978/j.issn.2223-4683.2013.01.05

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A New, Innovative, Lengthening Surgical Procedure for Peyronie’s Disease by Penile Prosthesis Implantation with Double Dorsal-Ventral Patch Graft: The “Sliding Technique”

Peyronie’s disease is the result of the formation of fibrous plaques in the tunica albuginea of the penis; typical presentations of the disease are represented by pain during erection, erectile dysfunction, and penile deformities, such as curvature, narrowing, and penile shortening. The most complex treatment is related to penile shortening.

Luigi Rolle, MD, PhD, Carlo Ceruti, MD, PhD, Massimiliano Timpano, MD, Omidreza Sedigh, MD, Paolo Destefanis, MD, Elisa Galletto, MD, Marco Falcone, MD, and Dario Fontana, MD

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Penile Reconstruction for Peyronie’s Disease

Although an infrapubic (IP) surgical approach for placement of a 3-piece inflatable penile prosthesis has an advantage over the penoscrotal approach for reservoir visualization, it has been less favored due to limited corporeal exposure and fear of injury to the neurovascular bundle.

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