Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation

In our article, “Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation,” we provide an analysis of a modern adaption of a well-established technique for correction of penile curvature. First described by Wilson and Delk in 1994, manual modeling during penile prosthesis insertion is a known treatment for men with concomitant erectile dysfunction (ED) and Peyronie’s disease (PD). The traditional technique allows for corporal straightening by employing two 90-second cycles of forcibly bending the fully inflated penis in the opposite direction of the maximal curvature. This process provides both immediate and delayed improvements in curvature via plaque disruption and remodeling with continued inflation of the device. Despite its efficacy, many prosthetic urologists are hesitant to utilize manual modeling due to a historically described 4% rate of urethral perforation and the lack of a completely straight phallus in the immediate post-operative period. Instead, urologists in contemporary practice are turning toward other straightening procedures such as plication and/or plaque excision/incision with grafting. While efficacious, these additional straightening procedures carry well-known risks such as penile shortening or glans paresthesias.

Optimal modeling (OM) is an update to the original manual modeling technique that includes performing as many cycles as necessary to achieve the desired penile straightness. Additionally, OM emphasizes the application of significant manual pressure to the distal urethra/glans penis at the fossa navicularis. We believe these two technical adjustments correct the two main complaints levied against manual modeling. This hypothesis was ultimately confirmed by our results, which demonstrated a ~37° improvement in penile curvature (mean 47.8° pre-modeling and 10.6° post-modeling). Further, 87.5% of patients had less than 15° of residual curvature and none required any additional straightening procedures. Importantly, no patients in our study experienced a Clavien-Dindo post-operative complication at a mean follow-up of 29.9 months. Additionally, optimal modeling added only seven minutes of additional operative time.

Optimal modeling advances a time-tested technique for concomitant erectile dysfunction and Peyronie’s disease. It is safe and effective at treating mild to moderate penile curvature at the time of penile prosthesis implantation. Importantly, OM provides a safe and simple solution to the intraoperative dilemma of newly-diagnosed curvature after cylinder inflation. Indeed, many patients who present to high-volume implanters have not had robust erections for some time and may not know they have any significant penile curvature. For such patients, optimal modeling may provide a needed solution with minimal added morbidity. Ultimately, modeling can provide safe and effective straightening while mitigating the risks associated with other straightening procedures.

Written by: Ryan M. Barlotta, DO, Jacob W. Lucas, DO, Jay Simhan, MD, Department of Urology, Einstein Healthcare Network, Philadelphia, PA; Department of Urology, Fox Chase Cancer Center, Philadelphia, PA

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