Patient-reported long-term sexual outcomes following plication surgery for penile curvature: A retrospective 58-patient study

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

BACKGROUND

Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined.

AIM

To provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus.

OUTCOMES

Objective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized.

RESULTS

Fifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of "treatment success" varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20˚. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes.

CLINICAL IMPLICATIONS

While both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting.

STRENGTH & LIMITATIONS

This report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review.

CONCLUSION

Both plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature. C. J. Britton, F. A. Jefferson, B. L. Findlay, et al. Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review. J Sex Med 2022;19:364-376.

Recent advances in managing Peyronie's disease

Treating men with Peyronie's disease remains a challenging problem facing clinicians working across urology and sexual medicine fields. Patients can often be left disappointed by current treatment paradigms, and an overall lack of suitable molecular targets has limited the options for novel, effective medical therapy. Managing men with Peyronie's disease often involves careful counselling alongside multifaceted and possible combination treatments to help improve symptoms whilst ameliorating potential side effects of therapy. We review the latest medical literature and evidence in the contemporary management of Peyronie's disease.

Long-term outcomes of surgery for Peyronie's disease: focus on patient satisfaction

Immediate outcomes of surgery for Peyronie's disease (PD) are fairly easy to analyze. However, it is the patient-reported long-term outcomes which eventually determine the success of PD treatment. The goal of this observational study was to evaluate patients' satisfaction with results of surgical treatment for PD at long-term follow-up. The primary outcome was the proportion of patients who were completely satisfied with their erectile function and penile appearance. We retrospectively identified 374 patients who underwent surgery for PD (median follow-up: 9.5 years) and attempted to invite them for follow-up visit; 342 patients were available for follow-up. Only 285 (83.3%) were sexually active. Among all patients, 197 (57.6%) were completely satisfied with penile appearance; among sexually active patients, 139 (40.6%) were completely satisfied with their erections. Only 101 patients (29.5%) were completely satisfied with penile appearance and erectile function. Logistic regression analysis revealed preoperative IIEF-EF score (OR = 1.668 per 1 point; 95% CI 1.469-1.894), tunica albuginea plication (OR = 5.599; 95% CI = 1.014-30.92), use of saphenous vein (OR = 8.517; 95% CI = 2.491-29.115), and cadaveric pericardium (OR = 61.388; 95% CI = 7.674-491.11) as significant predictors of satisfaction with erectile function. Severity of curvature (OR = 0.926 per 5°; 95% CI = 0.907-0.946) and tunica plication (OR = 0.117; 95% CI = 0.019-0.738) were negative predictors of satisfaction with penile appearance. Preoperative IIEF-EF (OR = 1.497 per 1 point; 95% CI = 1.322-1.694), severity of penile curvature (OR = 0.967 per 5°; 95% CI = 0.95-0.983), and use of pericardium allograft (OR = 10.728; 95% CI = 1.363-84.46) were predictors of both endpoints (satisfaction with erectile function and cosmesis). Despite excellent surgical outcomes in PD, patients' satisfaction with penile appearance and erectile function is far from absolute and depends on many patient-related and treatment-related factors.

Contemporary surgical and non-surgical management of Peyronie's disease

Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.

Patient satisfaction with correction of congenital penile curvature

BACKGROUND

Congenital penile curvature is a relatively rare disease, resulting from a deviation of the penis from the body's straight axis when erect. The prevalence is difficult to determine. Although it has been suggested that the condition could affect up to 10% of the male population, most of these deviations are minor, with no clinical or psychological importance, which leads to its underdiagnosis. Effective correction of the deviation can markedly improve the quality of life of adolescents with this condition.

OBJECTIVE

To assess the quality of the sex life of patients diagnosed with congenital penile curvature who underwent surgical correction.

MATERIALS AND METHODS

Design Retrospective, observational cohort study. Data was collected from the medical records of patients who underwent surgical correction of congenital penile curvature from June 2004 to August 2016. The patients completed the following self-administered questionnaires: Sexual Quality of Life Questionnaire-Male (SQOL-M), International Index of Erectile Function 5 (IIEF 5) and "How satisfied are you with the results of the surgery? From 0 to 10".

RESULTS

Twenty-two corporoplasties were performed to correct the patients' congenital penile curvature. The patients' average age was 23.4 years (range, 17-35). The mean deviation prior to surgery was 47.9° (range, 20°-90°). The average score on the SQOL-M was 52 points (range, 6-66). The average score on the IIEF 5 was 22.4 points.

CONCLUSION

Congenital penile curvature profoundly decreases quality of life, and early surgery is fundamental for repairing the anatomical deformation and thereby significantly restores the patients' psychosocial and sexual wellbeing.

Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes

BACKGROUND

Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature.

AIM

To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis.

METHODS

We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature.

OUTCOMES

Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups.

RESULTS

The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups.

CLINICAL IMPLICATIONS

The results of the present study indicate the two techniques can be used for penile plication.

CONCLUSION

With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142-e147.