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ResumeLa fibrose des corps caverneux est responsable d'une impuissance organique lorsque les lésions sont étendues.La restauration de l'activité sexuelle, et notamment des érections, passe par la mise en place d'une prothèse pénienne.Cette chirurgie est rendue difficile car il existe alors des modifications anatomiques importantes, avec induration et rétraction, pas toujours régulière, des corps caverneux.L'utilisation d'une double voie d'abord permet, au prix d'un risque infectieux potentiellement accru, une exposition totale, une implantation et une reconstruction plus aisées.L'étude de cette série limitée (19 patients) permet de dégager les causes, la technique, les précautions opératoires et péri-opératoires, les résultats, dans la prise en charge chirurgicale de ces fibroses graves des corps érectiles.AbstractExtensive cavernous body fibrosis is responsible for organic impotence when the lesions have advanced.Those fibrotic lesions can be caused by penile trauma, severe peyronie's disease, priapism (mostly post ICI) and rejection of a previously implanted prosthese.Sexual activity can be restored, mainly the erections, and is posiible with the insertion of penile prosthese. As a result of important anatomical changes, due to irregular indurations and retractions of the corpora, this surgery can be very difficult.The use of a double incisional approach (sub-coronal and perineal, degloving the penis out of its shaft through the perineal incision), allows, inspite of a potentially increased risk of infection, a total exposure making implantation and reconstruction much easier.The study of this limited series (from 1990 to 1996, 19 patients were operated with this procedure), allows to draw some preliminary conlusions about the pathology, the technique, the operatory (pre-, per-, and post-) precautions of this surgical procedure that treats serious erectile tissue fibrosis. Results are satisfactorily concerning recovery of penile rigidity as well as sexual activity.

Intérêt d'une double voie d'abord dans la chirurgie caverneuse complexe