Department of Urology and Pediatric Urology, Julius Maximilians University of Würzburg, Würzburg, Germany.
J Sex Med. 2018 Mar;15(3):416-421. doi: 10.1016/j.jsxm.2017.12.012. Epub 2018 Jan 8.
Correction of residual curvature during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) by plaque incision and grafting is a common approach.
To present a novel technique for residual curvature correction during IPP implantation using collagen fleece (TachoSil, Baxter Healthcare Corp, Deerfield, IL, USA).
After the IPP (Titan Touch, Coloplast, Minneapolis, MN, USA) is placed, the implant is inflated maximally. When residual curvature exceeds 40°, the PICS (penile implant in combination with the Sealing technique) technique is performed. The device is deflated, and a circumcising skin incision and penile degloving are performed. After elevation of the neurovascular bundle, the device is reinflated maximally. Plaque incision is performed at the point of maximum curvature using electrocautery. This leads to penile straightening because the tension is removed. In the next step, the defect of the tunica is closed with collagen fleece, which sticks to the tunica and defect without any sutures needed. The neurovascular bundle is reapproximated and the Buck fascia is closed. This is followed by closure of penile skin.
Primary outcome measurements were straightening rates, operative times, 5-item International Index of Erectile Function (IIEF-5) scores at follow-up, immediate and late complications, and patient satisfaction.
The PICS technique was applied to 15 patients. Mean patient age was 61.7 years (52-79 years). Mean residual curvature after IPP was 66.7° (50-90°). Mean operative time was 117.3 minutes (100-140 minutes). Mean follow-up was 15.1 months (1-29 months). 12 of 15 patients (80%) showed a totally straight penis. 3 patients (20%) had residual curvature of 10° at follow-up, which did not interfere with sexual intercourse. Mean IIEF-5 score at follow-up was 24.2 (22-25). No immediate or late complications occurred. All patients were satisfied with the surgical outcomes.
This novel technique prevents puncture or injury of the device, because the collagen fleece does not require suture fixation into the defect after plaque incision.
This technique can be applied to patients with severe PD who display residual curvature greater than 40° after IPP placement. It is a fast approach with low complication rates. Limitations include the small patient population and short follow-up.
The PICS technique represents a safe and time-saving approach for residual curvature correction during IPP placement in patients with PD and prevents device puncture. Hatzichristodoulou G. The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil. J Sex Med 2018;15:416-421.
在患有 Peyronie 病（PD）的患者中，通过斑块切开和移植物矫正可膨胀性阴茎假体（IPP）植入后的残余曲率是一种常见的方法。
介绍一种使用胶原蛋白绒片（TachoSil，Baxter Healthcare Corp，Deerfield，IL，USA）矫正 IPP 植入后残余曲率的新技术。
IPP（Titan Touch，Coloplast，Minneapolis，MN，USA）放置后，将植入物最大程度地充气。当残余曲率超过 40°时，进行 PICS（阴茎植入物联合密封技术）技术。将设备放气，并进行环形切口和阴茎脱套。抬高神经血管束后，将设备最大程度地重新充气。使用电烙术在最大曲率处进行斑块切开。这会导致阴茎伸直，因为张力被消除。下一步，用胶原蛋白绒片闭合尿道外膜的缺损，胶原蛋白绒片无需缝线即可贴合尿道外膜和缺损。重新接近神经血管束并关闭 Buck 筋膜。然后闭合阴茎皮肤。
主要的结果测量是伸直率、手术时间、随访时的 5 项国际勃起功能指数（IIEF-5）评分、即时和晚期并发症以及患者满意度。
PICS 技术可应用于患有严重 PD 的患者，这些患者在 IPP 放置后残余曲率大于 40°。它是一种安全且省时的方法，并发症发生率低。该技术可以应用于残余曲率大于 40°的严重 PD 患者，是一种快速、并发症发生率低的方法。局限性包括患者人群小和随访时间短。
