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Also known as
MoST, Modified 'sliding' technique, Egydio modified sliding technique, Penile lengthening without grafting technique, Modified sliding maneuver
Definition
The Modified Sliding Technique (MoST) is a surgical procedure for penile length restoration involving tunica albuginea incisions. It is specifically designed for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie’s disease (PD).1 This technique is a modification of the sliding technique originally described by Rolle in 2012, with the most notable differences being the use of a single subcoronal incision for penile degloving, mobilization and utilization of Buck’s fascia to cover defects in the tunica albuginea, and elimination of the need for graft material.2
The procedure begins with a circumferential subcoronal incision and degloving of the dartos fascia. Buck’s fascia is incised laterally to the urethra and dissected off the corporal bodies circumferentially to isolate the neurovascular bundle (NVB).3 An artificial erection is induced before mobilization of the corpus spongiosum off of the corpora cavernosa. The corporal bodies are marked ventrally in a semilunar manner from 3 to 9 o’clock 2–3 cm proximal from the coronal sulcus, dorsally from 9 to 3 o’clock 1.5 cm distal to the penoscrotal junction, and bilaterally via longitudinal markings that connect the prior dorsal/ventral markings.3
Longitudinal and semi-circular incisions are made to allow for penile straightening and lengthening. No graft material is used, allowing for a rectangular tunical defect in the proximal dorsal shaft. The distal ventral corpora defect is covered by the compressed cavernosum and corpus spongiosum, while Buck’s fascia is re-approximated to cover the proximal dorsal defect.1 This technique is notable in that no graft material is used, allowing for a rectangular tunical defect in the proximal dorsal shaft.2
Clinical Context
The Modified Sliding Technique is clinically indicated for patients experiencing actual or perceived penile shortening that causes significant distress or functional impairment.1 This is commonly seen in men with Peyronie’s disease, where plaque formation leads to penile curvature and shortening.1 Other indications include severe erectile dysfunction with significant penile shortening, post-radical prostatectomy penile shortening, androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, post-penile fracture, post-redo-hypospadias repair, and post-priapism.2
Patient selection is crucial and involves a thorough evaluation of the underlying cause of length loss, the patient’s medical history, psychological status, and realistic expectations.2 The procedure is typically performed in conjunction with penile prosthesis implantation, either malleable or inflatable.3
In a study of 143 patients who underwent the modified sliding technique, the causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy in 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%.1
Expected outcomes include an increase in penile length (average gain of 3.1 cm), correction of deformity (if present), and improvement in sexual function and psychological well-being.1 Recovery typically involves a period of rest, followed by rehabilitation protocols. Success rates are generally good when patients are appropriately selected and procedures are performed by experienced surgeons.1