title: A new, innovative, lengthening surgical procedure for Peyronie's disease by penile prosthesis implantation with double dorsal-ventral patch graft: the "sliding technique".
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To find a safe procedure in penile shortening due to Peyronie's disease providing a satisfactory lengthening, allowing an early stabilization of the penis, and preventing axial tension on the neurovascular bundles during dilation.
  
  
  METHODS
  We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa. Three patients, affected by Peyronie's disease with penile shortening and erectile dysfunction, underwent this procedure with approval of our local ethical committee. We evaluated the penis lengthening, intraoperative and postoperative complications, patient's preoperative and postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire).
  
  
  RESULTS
  The average operative time was 2 hours and 50 minutes. No major intraoperative nor postoperative complications occurred. No significant bleedings were recorded. Patients were discharged after 48-72 hours. The average increase in length obtained was 3.2 cm. All patients resumed sexual intercourses with satisfaction; no significant loss of sensitivity or any sign of vascular distress of the glans was recorded. The follow-up is 13 months. The average IIEF score is 60.
  
  
  CONCLUSIONS
  The lengthening of the penis by a double dorsal-ventral patch graft is an innovative procedure that is based on current techniques of plaque incision and grafting, and that can easily resolve severe shortening of the penis due to Peyronie's disease. In the cases presented, this procedure resulted easily, effectively, and safely. Nevertheless, the technique proposed in this article shall be validated through prospective studies with larger samples.
authors.affiliation: Divisione Universitaria di Urologia II, Dipartimento di Discipline Medico-Chirurgiche, Ospedale San Giovanni Battista-Molinette, Università degli Studi di Torino, Torino, Italy. luigi.rolle@unito.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Rolle
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceruti
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Timpano
authors.forename: Omidreza
authors.initials: O
authors.lastname: Sedigh
authors.forename: Paolo
authors.initials: P
authors.lastname: Destefanis
authors.forename: Elisa
authors.initials: E
authors.lastname: Galletto
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Dario
authors.initials: D
authors.lastname: Fontana
mesh_terms: D000368:Aged; D000818:Animals; D001705:Bioprosthesis; D003238:Connective Tissue / Q000601:surgery; D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019935:Penile Implantation / Q000379:methods*; D010411:Penile Induration / Q000601:surgery*; D015917:Penile Prosthesis; D011446:Prospective Studies