Residual penile curvature after inflatable penile prosthesis (IPP) placement is a recognized problem, which may require adjuvant procedures to achieve complete curvature correction.
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).
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.
The primary outcome was the degree of residual intraoperative curvature and secondarily the need for performing adjuvant maneuvers.
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).
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 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.
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.
The journal of sexual medicine. 2026 Apr 09 [Epub]
Yitzchak Katlowitz, Hisanori Taniguchi, Josep Torremade, Carolyn A Salter, John P Mulhall
Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States.