I introduced the PICS-Technique (Penile Implant in Combination with the Sealing Technique) in 2018 for residual curvature correction during penile prosthesis implantation in Peyronie’s disease, with the aim of reducing the risk of needle puncturing of the penile implant during plaque incision and grafting.1 This is achieved by using a self-adhesive collagen fleece (TachoSil, Corza Medical, USA) as graft.2 All other grafts for defect closure after plaque incision, that are currently available, need to be adjusted and sewed into the defect of the tunica albuginea. Thus, there is the risk of device puncturing and damage when passing the needle through the tunica several times. This does not apply for the collagen fleece. The collagen fleece has self-adhesive properties, meaning it sticks to the defect and the surrounding tunica without the need for suture fixation. As such, it makes it an ideal graft for residual curvature correction during penile prosthesis implantation in patients with Peyronie’s disease.
Together with colleagues from other renowned institutions, I have also published very good and promising long-term data on this PICS-Technique, showing this modern and forward-looking technique leads to reliable and excellent long-term results.3,4
In the current paper, that is published in The International Journal of Impotence Research, I performed the PICS-Technique for the first time worldwide in a patient with ventral residual curvature, after putting in the penile implant.5 This is a very special clinical scenario, as only 9% of all Peyronie patients display ventral penile curvatures. The surgical approach by plaque incision and grafting in these rare cases requires the mobilization of the urethra, which is demanding and needs good surgical skills and experience to avoid damage to the urethra. As such, a highly experienced and skilled reconstructive surgeon is required to perform this approach. In the current case, residual ventral curvature was 80° after device implantation and mobilization of the urethra (Fig. 1). This residual curvature was corrected completely by plaque incision at two sites ventrally and defect closure by the collagen fleece.
The second aspect, besides the fact of ventral residual curvature, that makes this case very special is that I performed the PICS-Technique for the first time worldwide by using a Rigicon penile implant. Rigicon implants are new on the world market and available since 2019. As such, performing the PICS-Technique with a Rigicon implant is special and important in order to assess the durability and feasibility of the Rigicon implants with the PICS-Technique. During surgery in the present case, the Rigicon implant showed controlled girth expansion without herniation or bulbing at the sites of the tunical defects. This makes it a robust implant for the PICS-Technique and comparable to the existing penile implants from other manufacturers.
Early follow-up data on this new and innovative technique with the new Rigicon implant in this special clinical situation with ventral residual penile curvature are very promising. However, long-term results and data from more patients treated with this straightforward surgical technique are needed.
Fig. 1: Ventral residual curvature 80°, after device insertion into the cavernous bodies and mobilization of the urethra. Implant inflated maximally.
Written by: Georgios Hatzichristodoulou, MD, MHBA, FEBU, FECSM, Professor, Chief and Head of Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
References:
- 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: p. 416-421.
- Hatzichristodoulou, G., Fiechtner S, Pyrgidis N, Gschwend JE, Sokolakis I, Lahme S, Suture-free sealing of tunical defect with collagen fleece afer partial plaque excision in 319 consecutive patients with Peyronie’s disease: The Sealing Technique. J Urol, 2021. 206: p. 1276-1282.
- Falcone, M., Preto M, Peretti F, Gontero P, Pyrgidis N, Sokolakis I, Hatzichristodoulou G., The use of collagen fleece to correct residual curvature during inflatable penile prosthesis implantation (PICS technique) in patients with complex Peyronie disease: a multicenter study. J Sex Med, 2023. 14(2): p. 229-235.
- Hatzichristodoulou, G., Yang DY, Ring JD, Hebert KJ, Ziegelman MJ, Köhler TS., Multicenter Experience Using Collagen Fleece for Plaque Incision With Grafting to Correct Residual Curvature at the Time of Inflatable Penile Prosthesis Placement in Patients With Peyronie's Disease. J Sex Med, 2020. 17(6): p. 1168-1174.
- Hatzichristodoulou, G., Gültekin MH, Özkara H, Akkus E, First Worldwide Correction of Ventral Peyronie’s Disease Utilizing Rigicon Inflatable Penile Prosthesis Combined with Plaque Incision & Grafting with Collagen Fleece (PICS-Technique) for Residual Curvature. Int J Impot Res, 2024. doi: 10.1038/s41443-024-00873-y.