SAPOC technique for length restoration in complex Peyronie's disease and erectile dysfunction at the time of penile prosthesis placement.

Abstract

Severe Peyronie's disease with concomitant erectile dysfunction remains surgically challenging, particularly in patients with significant curvature and penile shortening undergoing inflatable penile prosthesis implantation. We describe the SAPOC (Slices Around the Point of maximal Curvature) technique, a modification of the Multiple-Slit Technique, designed to permit length restoration while limiting large tunical defects and potentially reducing the need for structural grafting. Between October 2018 and December 2023, 64 patients with medically refractory erectile dysfunction and severe Peyronie's disease underwent inflatable penile prosthesis placement with SAPOC reconstruction by a single surgeon at a single academic center. Mean preoperative curvature was 72.0° ± 20.8° and mean stretched penile length increased from 14.2 ± 1.36 cm to 15.3 ± 1.2 cm (mean gain 1.05 ± 0.62 cm; p < 0.001). Complete intraoperative curvature correction was achieved in 73.4% of cases, with residual curvature <20° (mean postoperative curvature 3.3°) in the remainder. At median follow-up of 13.5 months (IQR: 9-22 months), 96.9% had no functionally significant curvature. Structural grafting (Cadaveric Pericardium) was required in only 7.8% of cases. Complications included one infection and no cases of glans necrosis. These findings suggest that SAPOC may represent a feasible reconstructive adjunct during inflatable penile prosthesis implantation that preserves tunical integrity while facilitating length restoration in selected patients. Further multicenter and comparative studies are needed to better define its safety profile and reproducibility.