123 Five year follow-up of plaque incision and vein grafting for Peyronie's disease

Long-Term Results of Reconstructive Surgery for Peyronie's Disease

INTRODUCTION

Peyronie's disease (PD) is an acquired benign connective tissue disorder that involves the tunica albuginea of the penis and can cause penile deformity and shortening. Because this condition is frequently associated with cardiovascular risk factors, a degree of erectile dysfunction is frequently present. The surgical management of PD should be offered once the acute phase of the disease has settled and the deformity is stable.

AIM

To critically review the most recent literature published on the surgical management of PD.

METHODS

A nonstructured PubMed-based review of the literature published in the last 10 years, searching for the words "Peyronie's disease," "erectile dysfunction," "plication," "grafting," "plaque," and "penile prosthesis," has been carried out.

MAIN OUTCOME MEASURE

The outcome of the various surgical procedures is reported.

RESULTS

Surgery represents at present the gold standard treatment for PD. The type of procedure should be decided according to the degree of deformity, the quality of the erection, and penile length.

CONCLUSIONS

Surgery still represents the gold standard treatment in patients with PD and aims at obtaining a penis straight, rigid, and long enough for penetrative sexual intercourse. Adequate preoperative patient's selection, counselling and the choice of the right type of procedure according to the degree of penile shortening, the type of deformity and the quality of the erection are paramount to achieving satisfactory results. Garaffa G, Kuehhas FE, De Luca F, and Ralph DJ. Long-term results of reconstructive surgery for Peyronie's disease. Sex Med Rev 2015;3:113-121.

Treatment of Peyronie's disease: 2012 update

Peyronie's disease (PD) is the occurrence of a fibrous inelastic scar of the tunica albuginea of the penis. It is a relatively common disorder among men, with a reported prevalence of 3% to 8%. It is often associated with penile pain, anatomical deformities in the erect state, and difficulty with intromission. Because the exact pathophysiology of PD remains unknown and standards for evaluating or reporting treatment outcomes are unclear, research on effective therapies has been limited. The benefits of nonsurgical treatment options are conflicting and further controlled studies are required before any therapy can be fully recommended. The success of surgery has been well documented; however, surgery is invasive and costly and carries potential side effects. Patients who report stable disease that has been present for longer than 12 months and who experience penile deformity preventing satisfactory sexual intercourse are best suited for surgery. Additionally, failed conservative management and a patient's preference for definitive correction are important additional indications for surgical treatment.

The management of Peyronie's disease: evidence-based 2010 guidelines

INTRODUCTION

The field of Peyronie's disease is evolving and there is need for a state-of-the-art information in this area.

AIM

To develop an evidence-based state-of-the-art consensus report on the management of Peyronie's disease.

METHODS

To provide state-of-the-art knowledge regarding the prevalence, etiology, medical and surgical management of Peyronie's Disease, representing the opinion of leading experts developed in a consensus process over a 2-year period.

MAIN OUTCOME MEASURES

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.

CONCLUSIONS

The real etiology of Peyronie's disease and the mechanisms of formation of the plaque still remain obscure. Although conservative management is obtaining a progressively larger consensus among the experts, surgical correction still remains the mainstay treatment for this condition.

Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up

INTRODUCTION

Limited publications exist regarding long-term outcomes of surgical correction for Peyronie's Disease (PD).

AIM

To report on long-term postoperative parameters including rigidity, curvature, length, sensation, function, and patient satisfaction in men with PD treated surgically via Tunica Albuginea Plication (TAP) or Partial Plaque Excision with Tutoplast Human Pericardial Grafting (PEG).

MAIN OUTCOME MEASURES

Objective and subjective data regarding patients who underwent either TAP or PEG.

METHODS

We report on 142 patients (61 TAP and 81 PEG) with both objective data and subjective patient reports on their postoperative experience. Patients underwent either TAP or PEG following our previously published algorithm. Data was collected via chart review and an internally generated survey, in which patients were asked about their rigidity, straightness, penile length, sensation, sexual function and satisfaction.

RESULTS

Average follow up for TAP patients was 72 months (range 8-147) and 58 months (range 6-185) for PEG patients. At survey time, 93% of TAP and 91% of PEG patients reported curvatures of less than 30o. Rigidity was reportedly as good as or better than preoperative in 81% of TAP and 68% of PEG patients, and was adequate for coitus in 90% of TAP and 79% of PEG patients with or without the use of PDE5i. Objective flaccid stretched penile length measurements obtained pre and postoperatively show an average overall length gain of 0.6 cm (range -3.5-3.5) for TAP and 0.2 cm (range -1.5-2.0) for PEG patients. Sensation was reportedly as good as or better than preoperative in 69% of both TAP and PEG patients; 98% of TAP patients and 90% of PEG are able to achieve orgasm. 82% of TAP patients and 75% of PEG patients were either very satisfied or satisfied.

CONCLUSION

Our long-term results support both TAP and PEG as durable surgical therapy for men with clinically significant PD.

Surgical treatment of Peyronie's disease based on penile length and degree of curvature

The aim of the study was to present the selection criteria for surgical techniques for the treatment of patients with Peyronie's disease. A total of 55 men with Peyronie's disease were surgically treated. We created specific criteria for selection of the appropriate surgical technique. All patients had a stable disease for 6 months and impossible vaginal intromission. All patients had subjective (as reported by the patient) and/or objective normal penile rigidity (as observed after intracavernous administration of alprostadil). Also, they all underwent drug therapy, which was unsuccessful. Among them, 40 patients with penile curvature of <60 degrees and erect penile length of >13 cm underwent Nesbit's operation, whereas plaque excision and grafting with polytetrafluoroethylene patch was performed in 15 patients with penile curvature of > or =60 degrees and/or erect penile length of < or =13 cm. At a mean (+/-s.d.) follow-up of 81.1+/-33.8 and 78.7+/-32.8 months, respectively, straightening of the penis was achieved in 35 out of 40 (87.5%) and 12 out of 15 (80%) patients, respectively, whereas erectile dysfunction developed in two out of 40 (5%) and one out of 15 (6%), respectively. Shortening of the penis occurred in all 40 patients undergoing Nesbit's operation, and in none of the patients undergoing plaque excision. Six out of 40 (15%) patients undergoing Nesbit's operation reported subjective perception of penis shortening, whereas none of the patients undergoing plaque excision complained of this discomfort. In conclusion, we recommend the selection of surgical technique based on penile length and degree of curvature. Nesbit's operation is an appropriate surgical technique for the treatment of patients with erect penile length of >13 and deviation of <60 degrees , whereas the plaque excision and grafting with polytetraflouroethylene patch is a technique of choice in the treatment of patients with erect penile length of < or =13 and/or deviation of > or =60 degrees.