Considerazioni medico legali sulla chirurgia protesica della disfunzione erettile in un caso di Malattia di La Peyronie.

Peyronie’s Disease is characterized by the presence of an inelastic fibrous plaque of the penile tunica albuginea affecting 3-10% of the male population. The fibrous scar causes the curvature of the erect penis, which prevents the penetration. In the stabilization phase the plaque can cause a variable degree of Erectile Dysfunction (20% -54%). In the treatment of the chronic disease, the gold standard is the surgery and in case of concomitant Erectile Dysfunction is indicated the placement of a penile prosthesis. This surgery is loaded of an increase of the variables which can affect the outcome, such as individual clinical features and functionality of the device. The case concerns a patient suffering from Erectile Dysfunction associated with Peyronie’s disease underwent surgery for implantation of hydraulic three-component penile prosthesis. After the surgery there was a malfunction of the prosthesis, which required unloading measures under sedation and a surgical revision of the scrotal pump. The latter was followed by the displacement of the prosthesis’ cylinder and by a new surgical treatment for the reintegration of the prosthesis and the repair of the right corpus cavernosum. After three months were a different positioning of the two cylinders inserted into the corpora cavernosa, with the right cranial extreme positioned 2.3 cm below the contralateral. In this case the failure of surgical treatment highlights a negligent behavior and the responsibility of the doctors by failing to examine adequately the variables, clinical and otherwise, that might affect the outcome of the intervention.