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Osmonov D, Ragheb A, Ward S, Blecher G, Falcone M, Soave A, Dahlem R, van Renterghem K, Christopher N, Hatzichristodoulou G, Preto M, Garaffa G, Albersen M, Bettocchi C, Corona G, Reisman Y. ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022; 10:100459. [PMID: 34823053 PMCID: PMC8847818 DOI: 10.1016/j.esxm.2021.100459] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function. AIM To review the evidence associated with surgical treatment of Peyronie`s Disease and provide clinical recommendations on behalf of the European Society for Sexual Medicine. 131 peer-reviewed studies and systematic reviews, which were published from 2009 to 2019 in the English language, were included. METHODS MEDLINE, Google Scholar and EMBASE were searched for randomized clinical trials, meta-analyses, open-label prospective and retrospective studies. MAIN OUTCOME MEASURE The panel provided statements on clinically relevant questions including patient involvement in the decision process, indications for surgery, choice of the approach, and the management of patient expectations. A comparison of the different grafts used in patients who have undergone plaque incision/excision and grafting in order to identify an ideal graft, has been carried out. The prevalence of postoperative complications has been summarized. Levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations. RESULTS In order to allow shared decision making, a patient preoperative counselling regarding the pros and cons of each intervention is recommended. In particular, adverse effects of surgical treatments should be discussed to set realistic understanding and expectations of surgical outcomes and ultimately improve postoperative satisfaction rates. Surgical treatment should be only offered in the chronic phase of the condition, when the deformity and/or degree of erectile dysfunction, prevent patients from engaging in satisfying sexual interaction, or if the deformity is the cause of severe bother. CONCLUSIONS Current European Society for Sexual Medicine recommendations cover several aspects of Peyronie's disease treatment. These recommendations aim both to ensure patients and partners have accurate and realistic expectations of their treatment options, as well as to formulate algorithms to guide clinician management pathways. Osmonov D, Ragheb A, Ward S et al, ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022;10:100459.
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Affiliation(s)
- Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Ahmed Ragheb
- Department of Urology, Beni-Suef University, Bedaya Fertility & IVF Hospitals, Kairo, Egypt
| | - Sam Ward
- Department of Urology, Clinique Saint Jean, Brussels; Medicis Medical Center, Woluwe, Belgium
| | - Gideon Blecher
- Department of Surgery, Monash University, Melbourne; Department of Urology, The Alfred Hospital, Melbourne, Australia
| | - Marco Falcone
- Department of Urology, University of Turin - Cittàdella Salute e dellaScienza, Turin, Italy
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nim Christopher
- The Institute of Urology, University College London Hospitals, London, UK
| | | | - Mirko Preto
- Department of Urology, University of Turin - Cittàdella Salute e dellaScienza, Turin, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Maarten Albersen
- Department of Urology, UZ Leuven Gasthuisberg Campus, Leuven, Belgium
| | | | - Giovanni Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
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Plication Without Degloving—Safe and Effective Technique for Correcting a Ventral Congenital Penile Curvature. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Plication for Correction of Congenital Penile Curvature: With or Without Degloving? Sex Med 2021; 9:100462. [PMID: 34753023 PMCID: PMC8766273 DOI: 10.1016/j.esxm.2021.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Previously, incisionless plication (IP) for correction of congenital penile curvature (CPC) has been performed after penile degloving via a circumscribing incision. Aim To describe our experience with non-degloving incisionless penile plication (NDIP) for correction of CPC and compare these outcomes with those of men who underwent degloving incisionless penile plication (DIP). Methods We conducted a retrospective review of men ≤ 45 years of age who underwent incisionless penile plication for correction of CPC between 2008 and 2020 at two adult tertiary hospitals. Patients underwent either NDIP, performed through a 2-3 cm longitudinal incision along the proximal-to-mid shaft opposite the point of maximum penile curvature, or DIP via a sub-coronal circumscribing incision. Main Outcome Measures Surgical and patient-reported outcomes were compared between the non-degloving and degloving groups. Results Among the 38 men (mean age, 26 years) who met the inclusion criteria, 25 underwent NDIP, including 6 patients with biplanar curvature (2 Ventral, 4 Dorsal, 6 Lateral). Thirteen patients underwent DIP, including 1 patient with biplanar curvature (1 ventral, 1 lateral). Curvature reduction was 50 ± 23 degrees for the NDIP group and 36 ± 10 degrees for the DIP group (P = .04). Five (20%) patients in the NDIP group and nine (69%) patients in the DIP group experienced a reduction in stretched penile length following plication (SPL) (P = .01). One patient in the NDIP group underwent an additional plication for recurrent curvature. Conclusion Both NDIP and DIP are safe and highly efficacious techniques for the correction of CPC. Kusin SB, Khouri RK, Dropkin BM, et al., Plication for Correction of Congenital Penile Curvature: With or Without Degloving?. Sex Med 2021;9:100462.
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Beano H, Morgan JT, Ortiz NM. Penile Plication in Peyronie’s Disease: Technique Evolution and Recent Advances. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00303-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: Contemporary evaluation and management. Int J Urol 2020; 27:504-516. [PMID: 32253786 DOI: 10.1111/iju.14230] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA.,Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Petar Bajic
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
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Ahn ST, Lee DH, Jeong HG, Kim JW, Moon DG. Scrotal septum detachment during penile plication to compensate for loss of penile length compared with conventional surgical technique. Investig Clin Urol 2020; 61:224-230. [PMID: 32158974 PMCID: PMC7052414 DOI: 10.4111/icu.2020.61.2.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of penile elongation featuring simple scrotal septum detachment from the penile base to compensate for the loss of penile length during penile plication in patients with Peyronie's disease compared with conventional penile plication. Materials and Methods We conducted a retrospective analysis of 38 patients (24–75 years of age) with Peyronie's disease who underwent penile plication with or without our novel technique from January 2009 to May 2018. Penile elongation was achieved by release and detachment of the scrotal septum from the penile base to the level of the scrotal fat tissue. The objective outcome of change in stretched penile length (SPL) and the subjective outcome of patient perception of postoperative penile length were compared between groups. Any postoperative complications were recorded. Results Of the 38 patients, 16 underwent penile plication with scrotal septum detachment (elongation group) and 22 underwent penile plication only (conventional group). The postoperative mean SPL was increased in the elongation group and decreased in the conventional group (1.2±1.3 cm vs. −0.5±0.3 cm, p<0.001). Fourteen of 16 patients (87.5%) in the elongation group reported perceived penile lengthening after surgery, whereas 17/22 patients (77.3%) in the conventional group complained of penile shortening. We encountered no procedure-related complications such as hematoma, infection, or necrosis in either group. Conclusions Simple detachment of the scrotal septum from the penile base afforded both objective and subjective penile elongation without any severe complications compared with conventional penile plication.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Dong Hyun Lee
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Hyeong Guk Jeong
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
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Reddy RS, Yi YA, Fuentes J, Bergeson RL, Davenport MT, Morey AF. Preventing the need for revision surgery after penile plication reconstruction of Peyronie's deformities. Transl Androl Urol 2020; 9:82-86. [PMID: 32055471 PMCID: PMC6995937 DOI: 10.21037/tau.2019.07.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The need for repeat penile plication (PP) for persistent penile deformity has previously been associated with (I) poor initial erectile response to intracavernosal injection (ICI), (II) an inadequate number of corrective sutures, and (III) a lack of sutures along the proximal shaft of the penis. We present our current experience with PP after implementing corrective measures to assess whether our need for revision surgery was reduced. METHODS We performed a retrospective review of patients who underwent PP for Peyronie's disease (PD) between 2009-2018 and had a minimum follow-up of 6 months. We updated our surgical technique in 2016 by (I) using supplemental intracorporal saline injections if the initial erection response to prostaglandin E1 injection was inadequate, (II) increasing numbers of corrective plication sutures, and (III) emphasizing more proximal suture placement. Patients were stratified into two groups and outcomes compared (prior technique versus current technique). RESULTS Of 472 PP patients who met inclusion criteria, 340 (72%) plication patients before 2016 were compared to 132 (28%) performed after 2016. The revision rate in the current cohort (1.5%, 2/132) decreased by more than half compared to the previous cohort (3.8%, 13/340). Mean preoperative angle of curvature was similar between the two groups (50.4 vs. 51.4 degrees, P=0.64), while the average residual postoperative degree was smaller in the current group (7.36 vs. 2.14 degrees, P<0.001). Fewer sutures were used in the early cohort than in the current (7.63 vs. 8.38, P=0.04). After revision, all cases were functionally straight, with a mean postoperative curvature of 4 degrees at a median follow-up of 10.6 months (IQR, 2.08-20.7). CONCLUSIONS Ensuring adequate rigidity with additional ICI and focusing a greater number of corrective sutures in a more proximal location appears to help prevent the need for revision plication surgery.
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Affiliation(s)
- Rohit S Reddy
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yooni A Yi
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jorge Fuentes
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rachel L Bergeson
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Allen F Morey
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
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García-Gómez B, González-Padilla DA, Alonso-Isa M, Medina-Polo J, Romero-Otero J. Plication techniques in Peyronie's disease: new developments. Int J Impot Res 2019; 32:30-36. [PMID: 31582822 DOI: 10.1038/s41443-019-0204-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/30/2019] [Accepted: 08/13/2019] [Indexed: 01/08/2023]
Abstract
To date, surgical correction remains the gold standard for patients with stable Peyronie's disease (PD) due to its high efficacy and low morbidity. Among the surgical procedures, penile plication (PP) can be offered to men who have adequate erectile function and penile length (>13 cm), with a curvature <60° and a predicted shortening of maximum 20% of the penis. The aim of this paper is to review the new developments that have emerged in the last years about the use of PP in patients with PD. A nonsystematic review of the literature was carried out searching in the PubMed and EMBASE databases from January 01, 2009 to April 01, 2019 including the words 'Peyronie', 'penile curvature', 'penile induration', 'plication', and 'plicature'. New developments in PP in the last 10 years include avoiding degloving by using a penoscrotal incision, a new mathematical model to predict loss of length after PP, a wider range of indications including patients with severe (≥60°) or complex curvatures, burying knots to avoid later discomfort, and thinning or incising the plaque to prevent excessive shortening. PP is a well-founded procedure with great results in appropriately selected patients. Given the lack of any prospective randomized trial, no clear recommendation can be made of one technique over another.
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Affiliation(s)
- Borja García-Gómez
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain.,Hospital Universitario HM Montepríncipe, Madrid, Spain
| | | | - Manuel Alonso-Isa
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain
| | - Jose Medina-Polo
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain.,Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Javier Romero-Otero
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain. .,Hospital Universitario HM Montepríncipe, Madrid, Spain.
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9
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Fang A, Wang R. Nondegloving technique for Peyronie's disease with penile prosthesis implantation and double dorsal-ventral patch graft. Asian J Androl 2019; 20:90-92. [PMID: 28959941 PMCID: PMC5753562 DOI: 10.4103/aja.aja_42_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A circumcising incision to deglove the penis for penile prosthesis (PP) implantation can increase the risk of ischemic injury to the glans penis. In order to avoid vascular complications, we describe a novel technique utilizing a ventral incision to perform the PP implantation and a double-dorsal patch graft, or “sliding technique” (ST), in patients with severe Peyronie's disease (PD). Three patients with severe PD and erectile dysfunction at our institution underwent ST and PP implantation through a ventral incision. This new approach was not only successful in facilitating the ST and PP implantation in these patients but also allowed for adequate exposure of the penile shaft with no reported loss of sensation. We also conducted a review of current literature regarding the approaches for PD. While ischemic complications of PP implantation and ST are rare, there are reports of ischemic injury in patients undergoing a circumcising incision. The combination of a circumcising incision and a patient's underlying peripheral artery disease potentially raises a patient's risk of this rare complication. Our innovative ventral incision provides an alternative method for PP implantation and ST in order to avoid ischemia of the penis, while still allowing for adequate exposure.
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Affiliation(s)
- Andrew Fang
- Division of Urology, University of Texas McGovern Medical School, Houston, Texas 77030, USA
| | - Run Wang
- Division of Urology, University of Texas McGovern Medical School, Houston, Texas 77030, USA.,Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Ziegelmann MJ, Farrell MR, Levine LA. Clinical characteristics and surgical outcomes in men undergoing tunica albuginea plication for congenital penile curvature who present with worsening penile deformity. World J Urol 2019; 38:305-314. [PMID: 31079186 DOI: 10.1007/s00345-019-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Men with congenital penile curvature (CPC) can develop new onset worsening of their lifelong curvature. We sought to evaluate clinical characteristics and postoperative outcomes after tunica albuginea plication (TAP) in patients presenting with CPC who reported new onset worsened curvature (CPC-WC), and compare these with patients reporting stable lifelong curve ("CPC-only"). METHODS A retrospective review of demographics, history/exam findings, and postoperative outcomes for patients with CPC who underwent TAP from 2012 to 2018 was performed. Patients were differentiated based on whether or not they reported new onset worsening of their penile curvature preoperatively (CPC-WC versus CPC only). Statistical analysis was performed to identify differences in clinical characteristics and postoperative outcomes after TAP. RESULTS 60 patients were included [CPC only (n = 39) and CPC-WC (n = 21)]. Mean curvature was 62° (SD 23). CPC-WC patients were older [median 34 years (IQR 27:52) versus 24 years (IQR 20:34); p = 0.004], and more likely to report penile shortening and psychological bother (p < 0.05). On physical examination, CPC-WCs were more likely to have a discrete palpable tunical scar and diminished penile elasticity (p ≤ 0.0002). With median follow up of 12 months, satisfactory straightening with TAP was reported in 56/60 patients (93%) including 35/39 (90%) CPC only and 21/21 (100%) CPC-WC. CONCLUSIONS In men undergoing TAP for CPC, we found that 35% reported new onset worsening of their original curvature preoperatively. These patients were older and more likely to report penile shortening or exhibit palpable tunical scarring with decreased elasticity on examination compared to those with lifelong stable curvature. Regardless, TAP resulted in satisfactory penile straightening in the majority of patients.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Michael Ryan Farrell
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA.
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Dell'Atti L, Polito M, Galosi AB. Is Degloving the Best Method to Approach the Penile Corporoplasty With Yachia's Technique? Urology 2019; 126:204-208. [DOI: 10.1016/j.urology.2018.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023]
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Reddy RS, McKibben MJ, Fuchs JS, Shakir N, Scott J, Morey AF. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018; 15:1498-1505. [PMID: 30228083 DOI: 10.1016/j.jsxm.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. AIM To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. METHODS We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. MAIN OUTCOME MEASURE Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. RESULTS Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3-84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P < .001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P < .001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P = .84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P > .1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P = .9) and post-operatively (19.4 vs 17.6, respectively, P = .15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P = .01) and pre-operative IIEF (odds ratio 1.14, P = .02). CLINICAL IMPLICATIONS PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. STRENGTH & LIMITATIONS This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. CONCLUSION Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498-1505.
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Affiliation(s)
- Rohit S Reddy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maxim J McKibben
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joceline S Fuchs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nabeel Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Scott
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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13
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Penile Length: Measurement Technique and Applications. Sex Med Rev 2017; 6:261-271. [PMID: 29289534 DOI: 10.1016/j.sxmr.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Penile size has long been an important fixation in men's lives. On the one hand, a smaller penis has been associated with anxiety and apprehension; on the other hand, a larger penis has generally been related to virility and strength. These perceptions predominate during an erection, when penile size is representative of a man's masculinity. AIM To assess adult penile length and summarize average penile length assessments from the literature; analyze how various urologic diseases and therapies affect penile length and volume; and review how surgical treatments for Peyronie's disease, penile prosthesis implantation, and radical prostatectomy can affect penile size to appropriately counsel patients seeking such therapies and set realistic goals for patients. METHODS To achieve the aim of this review, we analyzed the literature on penile size and volume and how these can be affected by various urologic diagnoses and therapies. We summarize common diagnoses and therapies that can affect penile size. MAIN OUTCOME MEASURE We thoroughly discuss how the aforementioned diagnoses and therapies can negatively affect penile size. In doing so, we allow readers to understand the intricacies of penile size when faced with such diagnoses and therapies in their patients. RESULTS Surgical treatments for Peyronie's disease, penile prosthesis implantation for refractory erectile dysfunction, and radical prostatectomy for prostate cancer can lead to a decrease in penile size. CONCLUSION Urologists must recognize that the different therapies they offer can affect a man's penile size, often negatively. This in turn can lead to poorer satisfaction outcomes in patients. Davoudzadeh EP, Davoudzadeh NP, Margolin E, et al. Penile Length: Measurement Technique and Applications. Sex Med Rev 2018;6:261-271.
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Kadirov R, Coskun B, Kaygisiz O, Gunseren KO, Kordan Y, Yavascaoglu I, Kilicarslan H. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017; 5:e142-e147. [PMID: 28711404 PMCID: PMC5562473 DOI: 10.1016/j.esxm.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/22/2017] [Accepted: 05/01/2017] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Rustam Kadirov
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Burhan Coskun
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey.
| | - Onur Kaygisiz
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | | | - Yakup Kordan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Hakan Kilicarslan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
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Cordon BH, Osmonov D, Hatzichristodoulou G, Morey AF. Peyronie's penile plication. Transl Androl Urol 2017; 6:639-644. [PMID: 28904896 PMCID: PMC5583063 DOI: 10.21037/tau.2017.07.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022] Open
Abstract
Penile plication has become the preferred surgical technique for Peyronie's disease (PD) as it can be performed efficiently, safely, with a high success rate, low morbidity and a low complication rate. Here in we describe two modern plication techniques in detail: the Kiels Knot plication and the minimally invasive penoscrotal plication. Benefits of the techniques include no palpable sutures for the Kiels Knot Plication and less surgical trauma for the penoscrotal plication. Plication has a low rate of failure. However, when it does occur it is usually secondary to under-correction. Failures typically present early postoperatively and a contributing factor to underestimating the deformity is a poor intraoperative artificial erection. Complex, severe, or multiplanar deformities will require more sophisticated intraoperative decision-making, but can be managed effectively with penile plication nonetheless.
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Affiliation(s)
- Billy H. Cordon
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, University Hospital of Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Allen F. Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S, Hakim L, Sadeghi-Nejad H, Broderick G. Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med 2017; 13:905-23. [PMID: 27215686 DOI: 10.1016/j.jsxm.2016.04.062] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/19/2016] [Accepted: 03/27/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. AIM To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. METHODS A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. MAIN OUTCOME MEASURES This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. RESULTS In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. CONCLUSION A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies.
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Affiliation(s)
- Eric Chung
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia.
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Ates Kagioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guilio Garaffa
- Institute of Urology, University College London Hospital, London, UK
| | | | - Trinity Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidney Glina
- Instituto H. Ellis and Department of Urology, Ipiranga Hospital, Sao Paulo, Brazil
| | - Lawrence Hakim
- Department of Urology, Cleveland Clinic Florida, Weston, FL, USA
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Chen R, McCraw C, Lewis R. Plication procedures-excisional and incisional corporoplasty and imbrication for Peyronie's disease. Transl Androl Urol 2016; 5:318-33. [PMID: 27298779 PMCID: PMC4893517 DOI: 10.21037/tau.2016.05.01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD.
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Affiliation(s)
- Roger Chen
- Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Casey McCraw
- Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ronald Lewis
- Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Shin SH, Jeong HG, Park JJ, Chae JY, Kim JW, Oh MM, Park HS, Kim JJ, Moon DG. The Outcome of Multiple Slit on Plaque with Plication Technique for the Treatment of Peyronie's Disease. World J Mens Health 2016; 34:20-7. [PMID: 27169125 PMCID: PMC4853766 DOI: 10.5534/wjmh.2016.34.1.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/18/2016] [Accepted: 03/19/2016] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the postoperative outcome of the multiple slit on plaque plication technique for the treatment of Peyronie's disease. Materials and Methods We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for the surgical treatment of Peyronie's disease, who had failed medical treatment between 2009 and 2014. Patients were grouped by preoperative degree of penile curvature into Group I: mild (n=5, 22.7%), Group II: moderate (n=11, 50.0%), and Group III: severe (n=6, 27.3%). After a thorough review of the medical records, we evaluated (a) the correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications. Results The mean postoperative follow-up period was 39 months. Complete correction of the curvature was attained in 21 patients (95.5%). As an inevitable complication, minimal penile shortening (<1.5 cm) was reported by 14 patients (82.4%) but did not adversely affect sexual intercourse (0%), and all patients found the extent of penile shortening to be acceptable. Nineteen patients had good erectile function (International Index of Erectile Function >21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months following surgery. Conclusions As a modified technique, multiple slit on plaque with plication is a simple, minimally-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss.
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Affiliation(s)
- Su Hwan Shin
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Guk Jeong
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Jin Park
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Ji Yun Chae
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Mi Mi Oh
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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19
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Abstract
Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.
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Affiliation(s)
- Uwais B Zaid
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, UC Clinics, San Francisco, CA, 94143, USA,
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20
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Chung PH, Tausch TJ, Simhan J, Scott JF, Morey AF. Dorsal Plication Without Degloving Is Safe and Effective for Correcting Ventral Penile Deformities. Urology 2014; 84:1228-33. [DOI: 10.1016/j.urology.2014.05.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
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Abstract
The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer-reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non-systematic review included 'Peyronie's disease', 'outcomes', 'complications', 'erectile dysfunction or ED', 'patient expectation', and 'patient satisfaction'; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty-one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non-surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug-resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long-term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence-based selection of the surgical approach.
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Affiliation(s)
- Culley C Carson
- Department of Surgery, Division of Urologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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22
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Chung PH, Scott JF, Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie's disease. J Sex Med 2014; 11:1593-8. [PMID: 24708140 DOI: 10.1111/jsm.12530] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Twenty to thirty percent of patients with Peyronie's disease (PD) have erectile dysfunction (ED) refractory to medical therapy and may benefit from a combined procedure addressing both conditions. AIM The aim of this study was to show the efficacy of inflatable penile prosthesis (IPP) insertion and synchronous penile plication for correcting penile curvature and ED in patients with PD. METHODS A retrospective review was performed of all patients who underwent IPP insertion with synchronous penile plication at our tertiary care center between 2010 and 2013. All patients received an intraoperative saline intracorporal injection to induce an artificial erection. After the tunica albuginea was exposed via a standard transverse scrotal incision over the proximal penile shaft, the incision was retracted distally and/or laterally as needed for plication suture placement. Plication sutures were placed in parallel opposite the angle of greatest curvature. The incision was returned proximally to the standard penoscrotal junction for IPP insertion. Demographic and surgical data were collected from the patients' medical records. Patient satisfaction was assessed postoperatively using a nonvalidated questionnaire. MAIN OUTCOME MEASURES The focus of this study was surgical outcomes, both technical and patient-reported satisfaction. RESULTS Eighteen patients with a mean age of 63 years underwent IPP insertion with synchronous penile plication. Patients presented with dorsal (n = 11), lateral (n = 2), and biplanar curvature (n = 5). Mean preoperative curvature was 39 degrees (range 30-60) and was corrected on average to <5 degrees (range <5-12) using a median of four plication sutures (range 3-6). Among 15 patients completing a postoperative satisfaction survey at a mean of 11 months, all reported improvement in their overall condition and penile curvature; one with biplanar deformity reported minor residual curvature. None reported continued pain or required suture release. CONCLUSIONS IPP insertion with synchronous penile plication for the correction of ED and PD is effective and results in high patient satisfaction.
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Affiliation(s)
- Paul H Chung
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Guillot-Tantay C, Phé V, Chartier-Kastler E, Mozer P, Bitker MO, Rouprêt M. [Medical and surgical treatments of congenital and acquired penile curvatures: a review]. Prog Urol 2013; 24:203-11. [PMID: 24560211 DOI: 10.1016/j.purol.2013.08.328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 08/05/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. MATERIALS AND METHODS [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. RESULTS The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. CONCLUSION Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.
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Affiliation(s)
- C Guillot-Tantay
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - V Phé
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
| | - E Chartier-Kastler
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - P Mozer
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - M-O Bitker
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - M Rouprêt
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
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Segal RL, Burnett AL. Surgical Management for Peyronie's Disease. World J Mens Health 2013; 31:1-11. [PMID: 23658860 PMCID: PMC3640147 DOI: 10.5534/wjmh.2013.31.1.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 03/10/2013] [Accepted: 03/24/2013] [Indexed: 11/15/2022] Open
Abstract
Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations.
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Affiliation(s)
- Robert L Segal
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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25
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Pendleton CM, Wang R. Peyronie's disease: current therapy. Transl Androl Urol 2013; 2:15-23. [PMID: 26816719 PMCID: PMC4708605 DOI: 10.3978/j.issn.2223-4683.2013.03.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/06/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clay M Pendleton
- Division of Urology, The University of Texas-Houston, Houston, TX 77030, USA
| | - Run Wang
- Division of Urology, The University of Texas-Houston, Houston, TX 77030, USA
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Mobley EM, Fuchs ME, Myers JB, Brant WO. Update on plication procedures for Peyronie's disease and other penile deformities. Ther Adv Urol 2013. [PMID: 23205060 DOI: 10.1177/1756287212448224] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plication techniques are not a panacea for deformities associated with Peyronie's disease or congenital curvature. However, they do provide certain advantages, both theoretic and real, over competing procedures such as grafting. Depending on the technique, plication procedures have minimal risk of de novo erectile dysfunction, minimal risk of injury to the dorsal neurovascular bundle, and may be used for a variety of angulation deformities, including multiplanar curvature and severe degrees of curvature. A variety of incisions may be used, including the classic circumcision with degloving but also ventral raphe, dorsal penile inversion, and penoscrotal. These may be helpful in preventing postoperative morbidity and in sparing the prepuce if desired. Plication may also be combined with procedures such as penile prosthesis for correction of residual curvature. Lastly, despite its complications, plication techniques are very well tolerated, are relatively simple to perform and result in the very high satisfaction rates.
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Jiménez-Pacheco A, Expósito-Ruiz M, Jiménez-Pacheco A, Verdú-Martínez M, Martínez-Romero C, López-Luque A. Análisis clínico y coste económico-sanitario de nuestra serie de 65 casos de incurvación de pene. Rev Int Androl 2013. [DOI: 10.1016/j.androl.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.
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Affiliation(s)
- Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
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Hudak SJ, Morey AF, Adibi M, Bagrodia A. Favorable patient reported outcomes after penile plication for wide array of peyronie disease abnormalities. J Urol 2012; 189:1019-24. [PMID: 23017514 DOI: 10.1016/j.juro.2012.09.085] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE We present patient reported outcomes from our 5-year experience using penile plication to correct a wide variety of Peyronie disease malformations. MATERIALS AND METHODS We reviewed the records of all men who underwent penile plication for Peyronie disease, as performed by one of us (AFM). All patients were treated with tunical plication without penile degloving via a 2 cm longitudinal penile incision regardless of curvature severity or erectile function. A concomitant inflatable penile prosthesis was placed in men with refractory erectile dysfunction. A questionnaire was administered to assess the patient perception of postoperative penile curvature, length, rigidity and adequacy for intercourse. RESULTS Of 154 treated patients 78 (51%) and 65 (42%) had simple (less than 60 degrees) and complex (biplanar curvature, or curvature 60 degrees or greater) malformation, respectively, while 11 (7%) underwent plication plus inflatable penile prosthesis placement. A total of 132 patients responded to the questionnaire a mean 14 months after surgery. Overall, 96% of patients reported curvature improvement after penile plication, 93% reported erection adequate for sexual intercourse and 95% considered that the overall condition improved after surgery. Despite a significant difference in the number of plication sutures (mean 10 vs 7) and curvature angle correction (mean 57 vs 30 degrees, each p <0.005), self-reported outcomes of complex cases were equivalent to those of simple cases. While 84% of patients had no measureable decrease in stretched penile length, 103 of 154 (78%) reported a perceived penile length reduction after surgery. CONCLUSIONS Penile plication without degloving is effective for correcting a wide variety of Peyronie disease malformations. It can be safely combined with inflatable penile prosthesis placement.
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Affiliation(s)
- Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
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Adibi M, Hudak SJ, Morey AF. Penile Plication Without Degloving Enables Effective Correction of Complex Peyronie's Deformities. Urology 2012; 79:831-5. [DOI: 10.1016/j.urology.2011.12.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/14/2011] [Accepted: 12/22/2011] [Indexed: 11/28/2022]
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Abstract
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.
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Morey AF. Re: Inflatable Penile Prosthesis Placement in Men With Peyronie's Disease and Drug-Resistant Erectile Dysfunction: A Single-Center Study. J Urol 2011. [DOI: 10.1016/j.juro.2011.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gur S, Limin M, Hellstrom WJG. Current status and new developments in Peyronie's disease: medical, minimally invasive and surgical treatment options. Expert Opin Pharmacother 2011; 12:931-44. [PMID: 21405946 DOI: 10.1517/14656566.2011.544252] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a wound-healing disorder of the tunica albuginea of the penis which affects 3-9% of adult males. Clinically, any combination of plaque formation, penile pain, angulation and erectile dysfunction may appear. This condition may progress, stabilize or, uncommonly, regress during the initial acute phase (6-18 months). AREAS COVERED Information regarding this review was searched in PubMed until August 2010. Vitamin E, paraaminobenzoate and colchicine are sparingly employed oral medical therapies. Intralesional injections as a minimally invasive therapy for PD includes injection with verapamil, interferon-α-2b, and collagenase. Men suffering with PD who have significant penile deformity precluding successful coitus can be appraised for surgical correction. Surgery is considered the gold standard and includes plication, incision and grafting- or penile-prosthesis-related procedures. EXPERT OPINION This paper provides a broad overview of the subject of PD, available nonsurgical options and surgical approaches that will aid in the routine clinical diagnosis and management of PD. Increased public and medical awareness of PD prevalence, presentation, diagnosis and treatment options will serve well the large population of men who suffer in silence with this common condition.
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Affiliation(s)
- Serap Gur
- Department of Urology, Health Sciences Center, Tulane University, New Orleans, Louisiana 70112, USA
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