The Peyronie’s Plaque “Scratch”: An Adjunct to Modeling

Dr. Paul PeritoUncategorized

Congratulations to Dr. Paul Perito MD, FACS and Dr. Stephen Wilson MD, FACS, FRCS on publishing a new technique in the 2013 Journal of Sexual Medicine to correct penile curvature due to Peyronie’s Plaque.

Peyronie’s Disease (also known as “Induratio penis plastica”,or more recently Chronic Inflammation of the Tunica Albuginea (CITA), is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

Dr. Pertio’s technique in the correction of this plaque prior to penile implantation:

Modeling (Wilson et al.) allows surgeons to correct most if not all Peyronie’s related curvatures when placing a penile prosthesis without having to use invasive and time-consuming procedures. The accepted rate of urethral disruption from modeling is nearly 5%. To diminish the possibility of this potential complication, the scratch procedure for internal disruption of the Peyronie’s plaque is used as an adjunct to modeling. The procedure can also be used to rid the implanted penis of any hour-glass defects commonly found prior to implantation in Peyronie’s patients.

An artificial erection is accomplished in order to identify the zone of pathology and mark it externally with a pen. An 80-mm nasal speculum is passed across the plaque and opened transversely to fracture the plaque along the x-axis.

A 12-blade scalpel is used to “scratch” the plaque internally along the z-axis, i.e., longitudinally. The depth of the “scratch” further disrupts the plaque along the y-axis, completing the internal three-dimensional disruption of the plaque. An alternative to using a scalpel for the linear incisions is using a pair of sharp Metzenbaum scissors to fracture the plaque.

Once the implant is in place, any additional modeling (Wilson et al.) may be performed. Remember to protect the urethra from distal perforation while modeling by squeezing the fossa. Risk of urethral perforation while modeling after the “scratch” should be diminished.

Below you will find the technique as published in the 2013 Journal of Sexual Medicine with illustrations to help you better understand this pre-implantation technique.

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Perito Urology Training Event

Dr. Paul PeritoUncategorized

May 8, 2013 – May 9, 2013

Dr. Paul Perito trained Doctors from around the world at Perito Urology following the AUA (American Urological Association) 2013 meeting.  The program, part of a world-wide training facility, welcomed 5 Brazilian and 2 Australian Urologists specializing in Penile Prosthesis Implantation to participate in the event.  The symposium comprised a tour of Perito Urology and a catered presentation by Dr. Perito, MD on The Perito Implant TM the evening of May 8th.  Surgical training followed on May 9th at Coral Gables Hospital, Florida where the visiting doctors were proctored on 16 penile implant cases.  All procedures were completed successfully in less than 7 hours.  Dr. Perito and attendees exchanged ideas and all agree that their skills to treat patient’s needing a penile implant have benefited significantly.  “I learn something new every time I work with such skilled surgeons”, claims Dr. Perito.  Many will take what they learned back to Brazil and Australia where they will continue successfully implanting patients using Dr. Perito’s Minimally Invasive Penile Implant, The Perito Implant TM.  Overall the event was fantastic!

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Las Vegas Welcomes Dr. Perito: Penile Implants and The Latest on Penile Cosmetic Surgery

Dr. Paul PeritoUncategorized

Dr. Paul Perito presents at 2013 American Academy of Cosmetic Surgery, 6th World Congress of the International Society of cosmetogynecology and Foundations of Liposuction Symposium. On January 16th Dr. Perito reviewed over 4000 of his cases utilizing both the penoscrotal and infrapubic technique. The Minimally Invasive technique that he developed was demonstrated to the congress and his results were presented to the congress. Dr. Perito also discussed the pitfalls of current techniques used for penile “cosmetic” surgery.

Dr. Paul Perito makes a special appearance on Telemiami’s Ganando Salud

Dr. Paul PeritoUncategorized

ganandoDr. Paul Perito makes a special appearance on Telemiami’s Ganando Salud.  The show provides audiences with information on health and science featuring prominent, South Florida doctors. Guest physicians guide spectators with advice, promoting prevention and good health encouraging the participation and questions of viewers.

Paul Perito Guest Stars on Radio Ideal Internacional

Dr. Paul PeritoUncategorized

Thursday, January 31st, Dr. Paul Perito guest stars on Radio Ideal Internacional. He joins their panel of professionals: Freddy Castro, Dr. Ana Pando, Dr. Juan Jimenez and Dr. Jorge Bordenave on Pideme Un Consejo. The program aims to improve listeners’ lives by providing useful tips in approaching everyday problems.

 

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Penile Implant Successfully Addresses Erectile Dysfunction Issues

Dr. Paul PeritoUncategorized

Penile Implant Successfully Addresses Erectile Dysfunction

Erectile dysfunction is not necessarily a consequence of age. It can, however, be the result of age-related physical disorders that cause narrowing of blood vessels in the penis. A penile implant is often a good option for men who have already made changes to their lifestyle and diet, considered psychosomatic causes, and tried medications such as Viagra or Cialis. Dr. Perito offers penile implants that can restore full sexual function to men of any age. The penile implant surgery is safe, effective, and discreet and can stop ED in its tracks before it has a further negative impact upon a man’s quality of life. Penile implants and penile implant surgery should be viewed as the last resort for restoring sexual function. It should only be considered when completely noninvasive options have all been exhausted with negative results. That being said, penile implants are extremely safe and effective and have very low failure rate. Dr. Perito’s minimally invasive penile implant surgery offers an expedient recovery and full restoration of sexual function, even if the patient has had ED for many years.

The fact of the matter is that most men experience at least temporary erectile dysfunction at some point in their adult life. The condition only becomes a problem when it begins to affect relationships or the self-esteem of the man with the condition. A healthy lifestyle, which includes avoiding tobacco and maintaining a healthy weight, may help minimize the instances of erectile dysfunction. Penile implants only come into play when the condition is chronic and pharmaceutical intervention is no longer sufficient.

An individual considering penile implant surgery should maintain an open line of communication with his primary care physician. Having an open and honest dialogue about symptoms – even if they do not seem related – may help to pinpoint the cause of the erectile dysfunction. The doctor will need to know specific medications, supplements and vitamins, as well as any herbal remedies that the patient may be using. It’s helpful to take along a spouse or partner to these early doctor appointments as they will have a unique perspective and may offer insight about the issue that the patient, himself, cannot.

 

Dr. Paul Perito Answers Questions about Penile Implant Surgery

Dr. Paul PeritoUncategorized

Patients undergoing penile implant surgery should follow their pre- and postop patient instructions carefully, cautions Dr. Perito. This will help to ensure an expedient recovery and a quicker return to a normal sexual function. Read on to find answers to frequently asked questions about penile implant surgery.

ARE THERE ANY OVER THE COUNTER DRUGS THAT SHOULD NOT BE TAKEN BEFORE SURGERY?
Patients should abstain from taking aspirin for one week (7 days) prior to a penile implant procedure, says Dr. Perito.

HOW IS THE OPERATIVE AREA STERILIZED?
Perito Urology patients are given an antibiotic as well as a container of surgical soap that needs to be used beginning one day prior to surgery.

CAN I EAT PRIOR TO MY PENILE IMPLANT PROCEDURE?
No, patients are advised not to consume any food or drink after midnight the night before the penile implant surgery. This includes water. Doing so may delay the procedure.

IS POSTOPERATIVE BRUISING NORMAL?
Yes, as is swelling. Both will generally resolve between seven and fourteen days.

WHAT ARE THE PHYSICAL RESTRICTIONS AFTER RECEIVING A PENILE IMPLANT?
Since penile implants are a surgically implanted device, care should be taken to avoid overexertion in the days and weeks following the procedure. The first 48 hours post-operatively should involve minimal activity and ice on the groin. Perito Urology patients are advised to lift no more than 10 pounds for two weeks. Showers may be taken on day two. The patient should begin hot shower direct soaks at 5 days (7 days if diabetic).

WHAT PAIN MEDICATIONS ARE RECOMMENDED FOLLOWING PENILE IMPLANT SURGERY?
Aleve® is recommended for up to two weeks. Pain medications may cause constipation, which will put pressure on the area and should be taken only to provide comfort.

AFTER THE PENILE IMPLANT IS IN PLACE, WHAT HAPPENS TO THE STITCHES AND BANDAGES?
Dr. Perito uses stitches to close the incision that are absorbable and require no patient action. There are small strips that cover the incision. These will likely fall off unnoticed in the shower. Additional bandages require removal.

WHAT POSITION SHOULD THE PENIS REST AFTER SURGERY? ?
For the first three days, the penis should be kept against the abdomen using the scrotal support tape that is supplied. After 72 hours, all penile implant patients should gently pull down on the penis several times a day while massaging the incision.

WHEN CAN THE PENILE IMPLANTS BE USED?
By 4 to 6 weeks most of Dr. Perito’s patients report that a normal an active sex life has been resumed.