title: Distal penile shaft reconstruction and reinforcement: the "double-windsocks" technique.
abstract: BACKGROUND
  The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons.
  
  
  OBJECTIVE
  To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis.
  
  
  METHODS
  Between August 2007 and August 2012, 69 patients underwent surgery for penile prosthesis protrusion (45 patients) or severe distal corporal fibrosis (24 patients). The mean age at the time of surgery was 56 years (range 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks").
  
  
  METHODS
  Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively.
  
  
  RESULTS
  Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases. Neuropraxia was reported in five cases (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively.
  
  
  CONCLUSIONS
  The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.
authors.affiliation: Center for Peyronie's Disease Reconstruction, Sao Paulo, Brazil.
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Egydio
authors.forename: Franklin E
authors.initials: FE
authors.lastname: Kuehhas
mesh_terms: D000328:Adult; D000368:Aged; D003075:Coitus; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019935:Penile Implantation / Q000009:adverse effects / Q000295:instrumentation*; D015917:Penile Prosthesis; D010413:Penis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Corporal Fibrosis; Distal Shaft Reconstruction; Distal Tip Reinforcement; Double-Windsocks Technique; Penile Prosthesis; Penile Prosthesis Protrusion