Egydio Medical Center, Sao Paulo, Brazil.
J Sex Med. 2020 Oct;17(10):2093-2103. doi: 10.1016/j.jsxm.2020.05.010. Epub 2020 Jul 4.
Peyronie's disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage.
The goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa.
Between February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie's disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting.
In accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity.
The sample of 416 patients included 287 cases of Peyronie's disease having a mean axial deviation of 51° (0-90°) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2-6) was measured intraoperatively.
Diagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient's subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics.
The TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle.
The TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity. Paulo H. Egydio, An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures. J Sex Med 2020;17:2093-2103.
阴茎纤维化是导致勃起功能障碍和阴茎缩小的主要原因，这些病因包括佩罗尼氏病、糖尿病、创伤、骨盆手术和衰老等。这些病症需要在术前进行客观诊断，并在术中处理阴茎缩小的问题。
开发一种非移植手术方法，通过在白膜上进行多个交错的小切口，以几何图案排列，在组织扩张和阻力之间达到最佳比例，从而限制圆柱体在海绵体内的运动，实现阴茎延长。
2016 年 2 月至 2019 年 2 月，416 例患有阴茎缩短症的患者（包括或不包括佩罗尼氏病）接受了使用白膜扩张术（TEP）的植入物治疗。切口分布在白膜的不同区域，以实现最大扩张，同时保持强度，将假体圆柱体限制在海绵体内，以防止隆起和凹陷。
根据这些原则，无论使用哪种植入物来获得足够的轴向刚性，都可以实现手术目标和患者对长度和周长恢复的满意度。
TEP 策略是一种非移植手术方法，基于组织扩张而不是替代，为外科医生提供了一种解决阴茎增大问题的方案，其增大程度受限于解剖的神经血管束。患者和外科医生根据个体解剖学特征选择植入物类型。TEP 策略已被证明是安全有效的，可以解决与阴茎弯曲无关的阴茎缩小问题。它消除了移植物的使用，并通过在白膜上进行小的、交错的切口来改善阴茎延长技术，同时保持白膜的结构阻力，将圆柱体限制在海绵体内，防止隆起和凹陷，促进组织再生，并提高轴向刚性。
