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.

BACKGROUND: 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. AIM: To present a novel technique for residual curvature correction during IPP implantation using collagen fleece (TachoSil, Baxter Healthcare Corp, Deerfield, IL, USA).
METHODS: 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. OUTCOMES: 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.
RESULTS: 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. CLINICAL IMPLICATIONS: 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. STRENGTHS AND LIMITATIONS: 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.
CONCLUSION: 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.