|
1
|
Natsos A, Tatanis V, Kontogiannis S, Waisbrod S, Gkeka K, Obaidad M, Peteinaris A, Pagonis K, Papadopoulos C, Kallidonis P, Liatsikos E, Drettas P. Grafts in Peyronie's surgery without the use of prostheses: a systematic review and meta-analysis. Asian J Androl 2024; 26:00129336-990000000-00152. [PMID: 38265253 PMCID: PMC11156445 DOI: 10.4103/aja202358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/07/2023] [Indexed: 01/25/2024] Open
Abstract
ABSTRACT Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.
Collapse
Affiliation(s)
| | | | | | | | - Kristiana Gkeka
- Department of Urology, University of Patras, Patras 26500, Greece
| | - Mohamed Obaidad
- Department of Urology, University of Patras, Patras 26500, Greece
| | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras 26500, Greece
- Department of Urology, Medical University of Vienna, Vienna 1090, Austria
| | - Petros Drettas
- Department of Urology, University of Patras, Patras 26500, Greece
| |
Collapse
|
|
2
|
Cai T, Capece M, Ceruti C, Tiscione D, Puglisi M, Verze P, Gontero P, Palmieri A. The Use of Vacuum Devices as Adjuvant Therapy before and after Penile Curvature Surgery in Patients Affected by La Peyronie's Disease: Results from a Comparative Study. Clin Pract 2023; 13:1244-1252. [PMID: 37887088 PMCID: PMC10605300 DOI: 10.3390/clinpract13050112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Peyronie's disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. METHODS All enrolled patients were assigned to the following groups: (a) the treatment group: VED treatment (three times per week) starting 3 months before surgery and (three times per week) one month after surgery; and (b) the control group: VED treatment (three times per week) one month after surgery. Follow-up urologic visits were scheduled for 3 and 6 months after surgery, and the two groups were compared. RESULTS A total of 38 patients were enrolled (median age 67 years, 57-74, IQR): 20 in the treatment group and 18 in the control group. At the follow-up visits, the two groups were different in terms of IIEF-5 (26 vs. 24; p = 0.02), "yes" to SEP2 and 3 (85% vs. 55%; p < 0.001, 85% vs. 50%; p < 0.001, respectively), and PDQ (-16 vs. -11; p = 0.03). Complete correction of penile curvature was achieved in 36 patients (94.7%). In the treatment group, no hourglass deformity was reported, whereas one patient reported a mild hourglass deformity in the control group. In the treatment group, we obtained a longer total penile length (median +1.5 cm). The overall satisfaction rate was 98% in the treatment group and 96% in the control group. CONCLUSIONS The VED treatment before penile curvature surgery in patients affected by PD was able to improve surgical outcomes.
Collapse
Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Hospital, 38122 Trento, Italy; (D.T.); (M.P.)
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Marco Capece
- Department of Urology, University of Naples, Federico II, 80138 Naples, Italy; (M.C.); (A.P.)
| | - Carlo Ceruti
- Department of Urology, University of Turin, 10124 Turin, Italy; (C.C.); (P.G.)
| | - Daniele Tiscione
- Department of Urology, Santa Chiara Hospital, 38122 Trento, Italy; (D.T.); (M.P.)
| | - Marco Puglisi
- Department of Urology, Santa Chiara Hospital, 38122 Trento, Italy; (D.T.); (M.P.)
| | - Paolo Verze
- Department of Urology, University of Salerno, 84084 Salerno, Italy;
| | - Paolo Gontero
- Department of Urology, University of Turin, 10124 Turin, Italy; (C.C.); (P.G.)
| | - Alessandro Palmieri
- Department of Urology, University of Naples, Federico II, 80138 Naples, Italy; (M.C.); (A.P.)
| |
Collapse
|
|
3
|
Ainayev Y, Zhanbyrbekuly U, Gaipov A, Suleiman M, Kissamedenov N, Zhaparov U, Urazova S, Rakhmetova N, Turebayev D, Keulimzhayev N, Zhankina R, Khairli G. Comparison of technical success and adverse events of plaque incision and grafting methods in patients with Peyronie's disease: Tunica vaginalis versus buccal mucosa. Urology 2022; 170:226-233. [PMID: 36115431 DOI: 10.1016/j.urology.2022.07.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of Peyronie's disease (PD) patients who were treated by plaque incision and grafting either with tunica vaginalis (TV) or buccal mucosa (BM) grafts. METHODS PD patients in BM (n=20) and TV group (n=20) were recruited between 2013 and 2020. Erectile dysfunction was assessed by short form of International Index of Erectile Function Questionnaire (IIEF-5). Technical success was defined as residual curvature ≤15°. Penile Doppler ultrasound was performed at baseline evaluation, 3-, and 24 months. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in erect penis. Erect penile length and curvature angle were measured at baseline and at 3, 12, and 24 months. RESULTS Mean age of the groups was comparable (47.2±10.8 years in TV vs 46.5±9.9 years in BM groups). Baseline mean penile curvature was 48.0±6.6° (TV) and 50.3±11.6° (BM) (p<0.001). Mean residual curvature at 24-months visits was 12.4±4.9° (TV) and 7.9±3.7° (BM), not significantly different. Technical success rate was 90% for both groups at 24 months. Surgery significantly increased erect penile length in both groups. Mean preoperative IIEF-5 scores were 18.4±2.5 and 17.5±2.2 in TV and BM groups, respectively. In both groups, IIEF-5 scores significantly improved after surgery with no intergroup IIEF-5 difference (20.6±2.6 in TV and 21.3±2.2 in BM). Mean postoperative PSV significantly increased, EDV significantly decreased in both groups, however, there was no significant intergroup difference. CONCLUSION Both grafting materials provided similar beneficial effects regarding technical success, erectile dysfunction, and penile length.
Collapse
Affiliation(s)
- Yernur Ainayev
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Ulanbek Zhanbyrbekuly
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Abduzhappar Gaipov
- Nazarbayev University, School of Medicine, Department of Medicine, Nur-Sultan, Kazakhstan
| | - Makhmud Suleiman
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan.
| | - Nurlan Kissamedenov
- JSC 'National Center of Neurosurgery', Department for Reception and Diagnosis, Nur-Sultan, Kazakhstan
| | - Ulan Zhaparov
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Saltanat Urazova
- Astana Medical University, Department of General Medical Practice No. 3, Nur-Sultan, Kazakhstan
| | - Nurila Rakhmetova
- Astana Medical University, Department of microbiology and virology named after Sh. I. Sarbasova, Nur-Sultan, Kazakhstan
| | - Dulat Turebayev
- Astana Medical University, Department of Surgery with an angiosurgery and plastic surgery course, Nur-Sultan, Kazakhstan
| | - Nurbol Keulimzhayev
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Rano Zhankina
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Gafur Khairli
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| |
Collapse
|
|
4
|
Autologous testicular tunica vaginalis graft in Peyronie's disease: a prospective evaluation. Int Urol Nephrol 2022; 54:1545-1550. [PMID: 35503401 DOI: 10.1007/s11255-022-03223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is a two-phase progressive condition characterized by inelastic plaques in the tunica albuginea of the penis, leading to curvature of the penis. Men with PD also suffer from psychological distress, and sexual life and overall quality of life. Although the preferred surgical treatment modality in Peyronie's disease is plaque incision and grafting, there is lack of studies assessing the erectile function and penile vasculature after the treatment. OBJECTIVES We aimed to evaluate the efficiency and safety of plaque incision and tunica vaginalis of testis grafting in PD. METHODS This was a prospective analysis. Erectile dysfunction was assessed via International Index of Erectile Function Questionnaire (IIEF-5). Penile Doppler ultrasound was performed to assess peak systolic velocity (PSV) and end-diastolic velocity (EDV). Postoperative follow-ups were scheduled at 3, 12, and 24 months. RESULTS Twenty patients (mean age 47.2 ± 10.8 years) were included. The mean preoperative penile curvature was 48 ± 6.6°. The technical success rate was 100% at 3 months and 90% at 24 months. At follow-up visits, mean erect penile length was no different from the baseline. The baseline mean IIEF-5 score was 18.4 ± 2.5. The mean IIEF-5 score was 20.6 ± 2.6 at 24-month visit (p < 0.0001). Mean PSV significantly increased, while EDV significantly reduced after surgery. There were no serious complications related to surgery. CONCLUSIONS We conclude that surgical reconstruction of penile curvature with tunica vaginalis grafting was a safe and effective procedure in PD.
Collapse
|