Intraoperative glanspexy during complex repair of Peyronie’s disease

Abstract

Abstract Background Men undergoing surgical correction of Peyronie’s disease (PD) have had intraoperative identification of a glans tilt or floppy glans not recognized preoperatively. Aim To describe the outcomes of a novel modified glanspexy performed on a large cohort of men with PD who also underwent a partial plaque excision or incision and grafting, tunica albuginea plication, or inflatable penile prosthesis (IPP) with straightening maneuvers. Methods A retrospective analysis (2016-2021) was performed on all patients who presented to a single surgeon with PD and were treated with a surgical procedure that included a glanspexy. Patients were tracked longitudinally, and interventions and outcomes were collected. All glanspexies were performed with the same surgical technique, where the glans was secured over the tips of the corpora cavernosa with several 4-0 Monocryl sutures between the glans and the tunica albuginea contralateral to the tilt through a subcoronal incision. Outcomes Our novel modified glanspexy technique resulted in excellent postoperative results with a high rate of durable repair. Results A total of 88 glanspexies were performed during surgery for PD with a median follow-up of 9 months (range, 1-77). All patients underwent a glanspexy plus partial plaque excision or incision and grafting (34.1%), tunica albuginea plication (10.2%), or an IPP with straightening maneuvers (55.7%). The most common direction of the glans tilt was dorsal (78.8%). Glanspexies were successful in 97.3% of patients, as only 2 (2.7%) had recurrent glans deformity >20° during the follow-up period. Our glanspexy technique repaired the glans deformity without compromising sensitivity or sexual function. Sensory complaints were noted in 1 patient (1.1%), who complained of hypoesthesia of the glans; however, there was no adverse effect on orgasm or ejaculation. A repeat glanspexy for recurrent glans deformity was performed on 1 patient (1.1%). Clinical Implications While most literature focuses on glanspexy after IPP placement, our article provides evidence for use of our glanspexy technique to repair glans hypermobility in patients with PD. Strengths and Limitations Our data are strengthened by the relatively large sample population and consistent outcomes regardless of straightening maneuver used. Conclusions regarding glanspexy and long-term satisfaction are limited by the lack of a validated questionnaire to illicit satisfaction during the postoperative period. Conclusion Glanspexy with 4-0 Monocryl suture on a TF needle appears to be a safe, easy, minimally invasive, and effective technique for the treatment of a glans tilt or floppy glans identified during the surgical management of PD.