Symposium on Peyronie's disease April 12, 1997

Regulatory issues in female sexual dysfunction

Female sexual dysfunction (FSD) remains an enigmatic area to some, a controversial area to others and the subject of continued, intense debate in the literature. Questions remain regarding the legitimacy of FSD as a bona fide disease; the definition of FSD; the methods of diagnosis; and, the treatment of FSD. In this timely perspective, Jean Fourcroy, Consultant in Urology, Endocrinology and Regulatory Issues, discusses the controversies that continue to plague FSD.

Peyronie's disease: surgical management: autologous materials

Peyronie's disease in men with satisfactory erectile function but with significant penile curvature is often treated with plaque incision or excision and grafting. The advantages and disadvantages of various grafting materials have long been debated. While artificial materials have been used, the inflammatory reaction from these grafts has produced poor results. Dermal, venous and tunica vaginalis grafts require additional operative time to harvest and their quality varies. Packaged grafts of autologous materials provide a readily available, reliable and well-tolerated choice for penile reconstruction for Peyronie's disease. These grafting materials including cadavaric pericardium, mammalian intestinal serosal products and others are easily obtained and provide a resilient yet compliant graft choice that is easy to tailor and suture in place. Host reaction is minimal and the infection risk small. Results of Peyronie's plaque incision/excision and autologous grafting are presented and the surgical procedures employed are outlined. Excellent results can be expected in the hands of the experienced reconstructive surgeon.

Development of a sexual function questionnaire for clinical trials of female sexual dysfunction

OBJECTIVE

To better evaluate efficacy in clinical trials of drugs as potential treatments for female sexual dysfunctions (FSD), a brief, multidimensional measure of female sexual function was developed.

METHODS

Data from semistructured interviews with 82 women with or without FSD, aged 19-65 years, generated a pool of 61 items that addressed aspects of female sexual function. On review by a panel, individual items were selected for face validity and clinical relevance. Thirty-one items were used as a sexual function questionnaire (SFQ-V1) in two multicenter, phase II clinical trials totaling 781 women with FSD. Normative data were generated from a sample of 201 women without FSD.

RESULTS

Factor analysis produced seven domains of female sexual function: desire, physical arousal-sensation, physical arousal-lubrication, enjoyment, orgasm, pain, and partner relationship. The internal consistency of the domains ranged from 0.65 to 0.91, and test-retest reliability ranged from 0.21 to 0.71 for Cohen's weighted kappa and 0.42 to 0.78 for Pearson's correlation coefficient. There was a significant difference between the baseline mean SFQ domain scores of patients with FSD compared with those of women without FSD (p < 0.0001). End-of-study SFQ scores were significantly different for women who reported improvement vs. women who reported no improvement (p < 0.001).

CONCLUSIONS

The SFQ produced seven domains of female sexual function with excellent internal consistency, moderate to good reliability, excellent discriminant validity, and sensitivity. The results suggest that the SFQ may be a valuable new tool for evaluating and diagnosing subsets of FSD and, ultimately, for evaluating treatments of these disorders.

Treatment of Peyronie's disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft

OBJECTIVES

To study the surgical treatment of Peyronie's disease using a single incision in the tunica albuginea and fibrotic plaque and repair of the defect by bovine pericardium graft.

METHODS

Between April 1999 and May 2001, 33 patients who had had symptoms of Peyronie's disease for more than 12 months and whose disease had been stable for more than 6 months underwent surgery. The reason for surgery was deformity of the penis that made sexual intercourse, even with erection, difficult or impossible. Two paraurethral incisions were made in Buck's fascia to separate the neurovascular bundle from the tunica albuginea. An incomplete circumferential incision, forked at the extremities, was made in the tunica albuginea and in the plaque at the point of maximal curvature, followed by a septal incision for the lengthening of the short side of the penis. A bovine pericardium graft was used to repair the defect in the tunica. All procedures were performed by a single surgeon (P.H.E.). The average follow-up time was 19.4 months (range 5 to 30).

RESULTS

No rejection or retraction of the graft was observed. All patients maintained their state of preoperative erection, with the penis corrected in 87.9% of cases and with discrete curvature (less than 15 degrees ) in 12.1%. All recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.21 cm (range 1 to 4) occurred in the size of the penis.

CONCLUSIONS

This procedure is effective for all types of penile deformity, regardless of the plaque characteristics.