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Chung D, Shiff B, Bal DS, Southall T, Blachman-Braun R, Grenier M, Flannigan R, Patel P. Insurance approval rates for collagenase clostridium histolyticum prior to discontinuation: a Canada-wide analysis. Int J Impot Res 2024; 36:581-587. [PMID: 37626201 DOI: 10.1038/s41443-023-00749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
Collagenase Clostridium histolyticum (CCh), the first approved non-surgical treatment for Peyronie's disease (PD), was withdrawn from the European, Canadian, and Asian markets due to poor demand and lack of government reimbursement options. We sought to assess insurance approval rates and usage of CCh across Canada to understand the factors that led to its withdrawal. Data on patients prescribed CCh for PD or Dupuytren's contracture was obtained through collaboration with BioScript Solutions to assess the association of variables with insurance approval and prescription filling. We identified 3297 insurance coverage applications for Xiaflex® from April 2018 to June 2020. Of all applications for PD, 92.9% applications were approved while 7.1% were rejected. Despite the withdrawal of CCh from Canadian markets, coverage application approval rates for 2018, 2019, and 2020 were 86.5%, 90.1%, and 89.1%, respectively. Of 2921 approved applications, 88.8% prescriptions were filled. For the 376 rejected applications, 66.4% of prescriptions were filled. Overall, 90% of the cost of Xiaflex® was covered in Canada among those with extended health benefits, with an out-of-pocket expense of $210.4. Insurance coverage requests for Xiaflex® were approved at a high rate in Canada with approved patients being very likely to proceed with therapy, despite interprovincial variation.
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Affiliation(s)
- David Chung
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Benjamin Shiff
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Dhiraj S Bal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas Southall
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Premal Patel
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
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2
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Eslahi A, Ahmed F, Askarpour MR, Nikbakht HA, Shamohammadi I, Ghasemi P, Alimardani H, Ebrahimi B. Outcomes of surgical correction of Peyronie's disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft. Asian J Urol 2024; 11:497-503. [PMID: 39220831 PMCID: PMC11364893 DOI: 10.1016/j.ajur.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/29/2023] [Indexed: 09/04/2024] Open
Abstract
Objective Peyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD. Methods A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention. Results There was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree (p<0.05) and satisfactory penile appearance (p<0.05) were seen in both groups without any superiority between the two groups (p=0.423 and p=0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups (p=0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance (p=0.255 and p=0.101, respectively). Conclusion Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohammad Reza Askarpour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Iman Shamohammadi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Ghasemi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanieh Alimardani
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Ebrahimi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Moncada I, Krishnappa P, Zaccaro C, Fraile A, Romero-Otero J, Martinez-Salamanca JI, Lledó-Garcia E. Penile prosthesis implantation is safe and effective in Peyronie's disease patients with and without erectile dysfunction. Int J Impot Res 2024:10.1038/s41443-024-00938-y. [PMID: 38909107 DOI: 10.1038/s41443-024-00938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Penile prosthesis (PP) is the mainstay of treatment in Peyronie's disease (PD) with co-existent refractory erectile dysfunction (ED). This study aimed to assess the clinical outcomes of patients who underwent PP as the first-line surgical treatment in PD without ED. A total of 636 patients underwent PP for PD from 2012 to 2022, but only 168 patients who underwent PP as first-line surgical management for PD with or without ED were included in the study. The mean (SD) age of 168 patients was 56.3 years (12.4). The mean curvature of the "PD with ED" group and the "PD without ED" group were 38.2 (5.6) degrees and 42.2 (5.9) degrees. The median (IQR) follow-up was 56.0 months (34.5- 61.4). Most (86.9%) patients underwent 3-piece inflatable PP. An important finding is that 33 patients (19.6%) without ED had undergone PP. Mechanical failure requiring revision surgery was less common in the 'without ED' group than in the ED group (6.8% vs. 10.2%, p 0.04). Most PD patients without ED (87.9%, 29/33) and with ED (88.9%, 120/135) were "satisfied" after PP implantation at six months, as defined by a score of ≥4 on a 5-point Likert scale. If surgery is offered in PD, PP may be considered a safe and effective first-line surgical treatment regardless of the ED, given the acceptable complications and high satisfaction rates. However, this new concept warrants further research.
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Affiliation(s)
- Ignacio Moncada
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain
| | - Pramod Krishnappa
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain.
- Andrology Division, Department of Urology, AndroNeo, Orchidz Health, NU Hospitals, Bangalore, 560010, India.
| | - Claudia Zaccaro
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain
| | - Augustin Fraile
- Department of Urology, Hospital Universitario Ramon y Cajal, 28034, Madrid, Spain
| | | | - Juan Ignacio Martinez-Salamanca
- Lyx Institute of Urology, Universidad Francisco de Victoria, Hospital Universitario Puerta De Hierro-Majadahonda, 28222, Madrid, Spain
| | - Enrique Lledó-Garcia
- Department of Urology, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
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Ceballos B, Baumgarten AS, Krug AM, Morey AF. Extratunical grafting for minimally invasive management of complex Peyronie's disease deformities. J Sex Med 2024; 21:579-581. [PMID: 38825575 DOI: 10.1093/jsxmed/qdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Penile deformities due to Peyronie's Disease (PD) often significantly impair men's sexual health and quality of life. AIM In this article we discuss the extratunical graft (ETG) procedure as a management strategy for PD patients with hourglass or indent penile deformities. METHODS We compiled descriptions of surgical techniques and performed a review of the literature regarding ETG for PD. OUTCOMES The ETG procedure appears to have promising results in the management of indent/hourglass deformity of PD. RESULTS The findings of this review of the literature demonstrate that ETG is a safe and effective reconstructive technique for penile deformity with minimal side effects. CLINICAL IMPLICATIONS We recommend utilizing ETG with or without plication for PD patients with indent or hourglass deformities. STRENGTHS AND LIMITATIONS Strengths of ETG are the improvement in patients with tunical indents and hourglass deformities secondary to PD. Additionally, patients who underwent ETG maintained sexual function given no significant change in penile length and intact erectile function. Limitations, however, are that the procedure is relatively new, and data are limited to small cohorts. CONCLUSION The ETG procedure is a safe and effective for management of complex PD in the short- and intermediate-term follow-up cohort.
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Affiliation(s)
- Brian Ceballos
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, 35233, United States
| | - Adam S Baumgarten
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, 35233, United States
| | - Aaron M Krug
- Urology Clinics of North Texas, Dallas, TX, 75231, United States
| | - Allen F Morey
- Urology Clinics of North Texas, Dallas, TX, 75231, United States
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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; 26:250-259. [PMID: 38265253 PMCID: PMC11156445 DOI: 10.4103/aja202358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/07/2023] [Indexed: 01/25/2024] Open
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.
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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
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Chung E, Gillman N. Commentary on "Intermediate-term results of TachoSil grafting to correct residual curvature during inflatable penile prosthesis implantation in patients with Peyronie's disease.". Int J Impot Res 2024; 36:293-294. [PMID: 38509347 DOI: 10.1038/s41443-024-00858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Eric Chung
- The University of Queensland, Brisbane, QLD, Australia.
- Princess Alexandra Hospital, Brisbane, QLD, Australia.
- AndroUrology Centre, Brisbane, QLD, Australia.
| | - Nicholas Gillman
- The University of Queensland, Brisbane, QLD, Australia
- Princess Alexandra Hospital, Brisbane, QLD, Australia
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Roadman D, Quesada-Olarte J, Langbo W, Mossack S, Levine L. Experience With Extra-Tunical Grafting and Tunica Albuginea Plication for Correction of Indentation Deformity in Men With Peyronie's Disease. Urology 2024; 186:17-22. [PMID: 38395079 DOI: 10.1016/j.urology.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To further evaluate extra-tunical grafting (ETG), a relatively new surgical option to treat corporal indentation in those with Peyronie's disease without buckling or hinge effect, we report our experience, patient satisfaction, and surgical outcomes. METHODS Retrospective review of patients following ETG, including pre-operative deformity, type of graft, graft location (under or over Buck fascia), patient characteristics, and satisfaction. Overall cosmetic satisfaction with deformity correction between patients undergoing 2 different ETG locations and 3 different types of grafts, as well as perceived bother of graft visibility and palpability were assessed. RESULTS From 2018-2023, 35 patients underwent ETG and tunica albuginea plication (TAP) with 89.6% of patients having persistent correction on office examination at a median (interquartile range) follow-up of 23.5 (15.2) months. Overall satisfaction with penile appearance by grafting location via patient-reported questionnaires showed no statistical difference (P = .47). Patients undergoing TAP and ETG were satisfied with their erect appearance regardless of graft material. Patients reported grafting tissue was palpable (74.3%) and visible (48.6%) in the flaccid state as compared to the erect state (8.6% and 5.7%). CONCLUSION ETG presents a less invasive surgical option than traditional approaches to correct indentation deformities not associated with instability. Our experience shows high patient satisfaction rate following correction of indentation using graft tissue when placed under or over Buck fascia. At a median follow-up of almost 2 years, patients had persistent correction, and while some report visibility of the graft and palpability in the flaccid state, this tends to disappear in the erect state.
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Affiliation(s)
- Daniel Roadman
- Rush University Medical Center, Department of Urology, Chicago, IL
| | | | - William Langbo
- Rush University Medical Center, Department of Urology, Chicago, IL
| | - Spencer Mossack
- Rush University Medical Center, Department of Urology, Chicago, IL
| | - Laurence Levine
- Rush University Medical Center, Department of Urology, Chicago, IL.
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Feyisetan O. Peyronie's Disease: A Brief Overview. Cureus 2023; 15:e37037. [PMID: 37143639 PMCID: PMC10153789 DOI: 10.7759/cureus.37037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/04/2023] Open
Abstract
Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable penile plaque. It is more common in Caucasian men over the fifth decade of life, but it is an under-reported disease. Conservative and non-surgical options are supported by limited evidence except for intralesional injection of collagenase clostridium histolyticum and have limited success. The improved outcome of surgical treatment is accompanied by the risk of erectile dysfunction. This is a brief overview of Peyronie's disease, its impact on the patient, and the available treatment options.
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Ziegelmann MJ, Byrne E. EDITORIAL COMMENT. Urology 2022; 170:231-232. [DOI: 10.1016/j.urology.2022.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Piraino J, Chaudhary H, Ames K, Okoye F, Sterling M, Clavell-Hernandez J, Levine L, Ziegelmann MJ. A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature. Sex Med Rev 2022; 10:698-713. [PMID: 37051957 DOI: 10.1016/j.sxmr.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Treatment recommendations for Peyronie's Disease (PD) differ based on whether a patient is in the acute/active versus chronic/stable phase of the disease, yet there are no agreed upon criteria for defining these clinical entities. OBJECTIVES To review the criteria used to define acute and chronic phase PD in modern PD intervention studies. METHODS We performed a search engine review to identify indexed publications for PD intervention studies and review articles / meta-analyses from the year 2011-2020. Outcomes results were catalogued and summarized across articles. As a result of the substantial heterogeneity of outcome measures and follow-up intervals, meta-analytic techniques were not applied to the data analysis. RESULTS We identified a total of 104 studies that met inclusion criteria and had available information for review (n = 79 primary intervention studies; n = 25 review articles/meta-analyses/guidelines). Among the queried studies, we were unable to identify a consensus with respect to the criteria used to define acute and chronic phases of PD. 33% of primary intervention studies did not specifically define their criteria for acute and chronic phase PD, despite referencing these populations as part of the inclusion criteria in many instances. Studies used heterogenous criteria including total symptom duration, duration of "stable" symptoms, and presence/absence of pain. CONCLUSION Due to varying definitions across the literature, we were unable to create a standardized definition of acute and chronic phase Peyronie's in terms of time. Our findings emphasize the need for greater consensus in defining the treatment cohorts with future studies that assess treatment for men with PD.
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [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: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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Edler Zandoná PC, Teixeira NP, Oliveira HE, Soares Garcia JH. The use of a polyglycolic acid polymer graft in Peyronie's disease - preliminary outcomes. Arch Ital Urol Androl 2022; 94:87-90. [PMID: 35352532 DOI: 10.4081/aiua.2022.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Plaque incision and grafting is indicated for patients with Peyronie's Disease [PD] and severe curvature, complex deformities or for patients with significant penile shortening. To date, no graft studied has been considered ideal. The aim of this study is to conduct a descriptive analysis about functional results with the use of a bioabsorbable graft for PD treatment. MATERIALS AND METHODS A single-center, retrospective evaluation of a cohort of patients who were treated by plaque incision and grafting with a polyglycolic acid polymer graft (Gore® Bio-A®) between 2018 and 2021 was conducted. Correction of penile curvature was the main outcome. Loss of penile sensitivity, de novo erectile dysfunction and any other adverse event were the secondary endpoints. RESULTS 14 patients were included in this study (mean age 59.5 ± 7.2 years). The median follow-up time was 12 months (range 3-12). The curvature correction rate was 78.5%. Glans hypoesthesia was present in one of 14 patients (7.1%) and refractory erectile dysfunction was reported in 64.2%. None of the patients presented any major adverse event based on Clavien-Dindo classification. CONCLUSIONS Curvature correction and changes in penile sensitivity rates were similar to those found in the literature. No major surgical complications, such as graft rejection, infection, and extrusion, occurred in this sample. Although a population with a higher prevalence of erectile dysfunction was included in this sample, higher rates of refractory erectile dysfunction were observed and these findings should be confirmed in further studies.
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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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Gundogdu G, Okhunov Z, Starek S, Veneri F, Orabi H, Holzman SA, Sullivan MP, Khoury AE, Mauney JR. Evaluation of Bi-Layer Silk Fibroin Grafts for Penile Tunica Albuginea Repair in a Rabbit Corporoplasty Model. Front Bioeng Biotechnol 2021; 9:791119. [PMID: 34950646 PMCID: PMC8688800 DOI: 10.3389/fbioe.2021.791119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
Abstract
The use of autologous tissue grafts for tunica albuginea repair in Peyronie's disease and congenital chordee is often restricted by limited tissue availability and donor site morbidity, therefore new biomaterial options are needed. In this study, bi-layer silk fibroin (BLSF) scaffolds were investigated to support functional tissue regeneration of tunica albuginea in a rabbit corporoplasty model. Eighteen adult male, New Zealand white rabbits were randomized to nonsurgical controls (NSC, N = 3), or subjected to corporoplasty with BLSF grafts (N = 5); decellularized small intestinal submucosa (SIS) matrices (N = 5); or autologous tunica vaginalis (TV) flaps (N = 5). End-point evaluations were cavernosography, cavernosometry, histological, immunohistochemical, and histomorphometric assessments. Maximum intracorporal pressures (ICP) following papaverine-induced erection were similar between all groups. Eighty percent of rabbits repaired with BLSF scaffolds or TV flaps achieved full rigid erections, compared to 40% of SIS reconstructed animals. Five-minute peak erections were maintained in 60% of BLSF rabbits, compared to 20% of SIS and TV flap reconstructed rabbits. Graft perforation occurred in 60% of TV group at maximum ICP compared to 20% of BLSF cohort. Neotissues supported by SIS and BLSF scaffolds were composed of collagen type I and elastin fibers similar to NSC. SIS and TV flaps showed significantly elevated levels of corporal fibrosis relative to NSC with a corresponding decrease in corporal smooth muscle cells expressing contractile proteins. BLSF biomaterials represent emerging platforms for corporoplasty and produce superior functional and histological outcomes in comparison to TV flaps and SIS matrices for tunica albuginea repair.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Stephanie Starek
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Faith Veneri
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Hazem Orabi
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Sarah A Holzman
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Urology, Children's Hospital of Orange County (CHOC), Orange, CA, United States
| | - Maryrose P Sullivan
- Department of Surgery and Harvard Medical School, Boston, MA, United States.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, MA, United States.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Antoine E Khoury
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Urology, Children's Hospital of Orange County (CHOC), Orange, CA, United States
| | - Joshua R Mauney
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
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15
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Peyronie disease: Our first experience with Ducket Baskin tunica albuginea plication (TAP) technique. Int J Surg Case Rep 2021; 87:106451. [PMID: 34624830 PMCID: PMC8501669 DOI: 10.1016/j.ijscr.2021.106451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Peyronie's Disease is a deformity of the penis. Surgical procedure options for Peyronie's disease treatment include grafting (curvature >60°) or plication (curvature <60°). This case report emphasizes the curvature degree and therapy options chosen, such as tunica albuginea plication instead of grafting. CASE PRESENTATION A 55-year-old male complains about a curved penis during erection. Examination shows penile bending 70° ventrally with ±15 cm length and 2x4cm size. The patient underwent Ducket-Baskin tunica albuginea placation (TAP). Postoperative unbent penis size decrement of ±3 cm, neither pain nor erectile dysfunction felt. CLINICAL DISCUSSION Tunica plication is usually recommended in Peyronie's disease patients with curvature less than 60°, without an hourglass or hinge if grafting is not available. This technique is more simple, safe, the higher success rate of curvature correction (> 80%), low recurrency, low complication rate of penile hypoesthesia (approximately 10%), as well as low risk for postoperative erectile dysfunction. CONCLUSION In our case, the tunica albuginea plication technique gives a good outcome in Peyronie's disease reconstruction.
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16
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Penile Extra-Tunical Graft Reconstruction of Peyronie's Disease Concavity Deformities. Urology 2021; 158:237-242. [PMID: 34474042 DOI: 10.1016/j.urology.2021.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To report our initial experience with the extra-tunical grafting (ETG) procedure. This procedure was recently introduced by UCSF investigators as a tunica-sparing technique for management of penile concavity deformities. METHODS We retrospectively reviewed records of patients who underwent ETG at our tertiary-care referral center between 2017 - 2020. A collagen graft made from bovine pericardium (Lyoplant) was placed overlying the defect without violating the tunica albuginea or mobilizing the neurovascular bundle. The stretched penile length (SPL) and circumference at the location of deformity were measured intra-operatively. Patient reported outcomes were evaluated by an anonymous 10-question online survey. RESULTS 19 men underwent ETG with a median follow-up of 59 (IQR: 24 - 708) days. ETG was performed via either a window (15/19, 78%) or a de-gloving (4/19, 21%) incision with concomitant penile plication performed in 16/19 (84%) patients. Penile circumference increased by an average of 1.4 cm + 0.5 (P = 0.03) at the location of deformity, while pre- and post-operative SPL were similar (14.0 + 1.4 vs 14.0 + 1.3 cm, P = 0.95). Overall patient satisfaction was reported by 13/15 (86%) patients. Twelve out of 15 (80%) patients reported concavity deformity to be "improved", with 73% reporting "much better". Among 8 patients with follow up greater than six months, graft palpability was reported in 4/8 (50%) patients but was not bothersome. CONCLUSION The ETG procedure appears to be safe and effective for the treatment of penile concavity deformities. Patient outcomes and satisfaction are favorable at intermediate follow up.
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17
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Punjani N, Nascimento B, Salter C, Flores J, Miranda E, Terrier J, Taniguchi H, Jenkins L, Mulhall JP. Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients. J Sex Med 2021; 18:1258-1264. [PMID: 37057415 DOI: 10.1016/j.jsxm.2021.05.006] [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: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intralesional collagenase such as Xiaflex (ILX) has become a standard treatment for Peyronie's disease (PD). Many robust studies have demonstrated its clear efficacy in the treatment algorithm. AIM To examine predictors of the patient decision to pursue ILX in PD patients. METHODS The study included PD patients (i) with stable disease (ii) who had doppler duplex ultrasonography (DUS) at least 6 months prior to analysis date and (iii) did not choose an operation. All patients received a standard discussion regarding treatment options, specifically, observation, ILX and penile reconstructive surgery (plication, plaque incision and grafting, implant surgery). Patients who opted to use ILX were compared to those who opted against it. Comorbidity, demographic and PD characteristics were recorded at the initial PD visit. All patients completed three validated questionnaires including the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire and a depression questionnaire (CES-D). Logistic regression was used to determine predictors of ILX use. OUTCOMES Predictors of ILX utilization. RESULTS Four hundred and fifty stable PD men had DUS completed 6 months before to allow sufficient time for treatment decision. Of these, 111 (24.7%) patients had ILX treatment and 339 (75.3%) did not. Mean age, relationship status and pain occurrence were similar between groups, but ILX patients had less bother defined as PDQ ≥ 9 (46.8% vs 53.7%, P = .02). ILX patients had more complex curves (79.3% vs 47.8%, P < .01) and more severe instability (32.4% vs 15.3%, P = .01). ILX patients also had higher PDQ domain scores (Psychological 11.5 ± 6.4 vs 7.5 ± 6.2, P < .01; Pain 6.2 ± 6.0 vs 4.3 ± 5.6, P = .02; and Bother 9.8 ± 4.7 vs 6.6 ± 4.8, P < .01). On univariable statistics, significant bother (OR 2.41, 95% CI 1.36-4.28, P<0.01), complex curvature (OR 4.18, 95%CI 2.52-6.93, P < .01), moderate and/or severe instability (OR 1.98, 95%CI 1.18-3.30, P < .01) and PDQ-Bother scores (OR 1.15, 95%CI 1.08-1.22 P < .01) predicted ILX use. On multivariable analysis, instability (OR 2.58, 95%CI 1.02-6.57, P = .05) and significant bother (OR 1.23, 95%CI 1.04-1.45, P = .01) predicted ILX use. CLINICAL IMPLICATIONS Educates providers as to which patients are more likely to choose ILX. STRENGTHS & LIMITATIONS Our study has a large sample size and all patients received the same standardized treatment discussion. Our study is limited by the absence of insurance data on all patients, and its retrospective single center design. CONCLUSION ILX was chosen by the minority of stable PD patients. While moderate to severe instability and significant bother is predictive of ILX use, other demographic factors including relationship status, sexual orientation or pain were not. Punjani N, Nascimento B, Salter C, et al. Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients. J Sex Med 2021;18:1258-1264.
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Affiliation(s)
- Nahid Punjani
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
- Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine of Cornell University
| | - Bruno Nascimento
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
- Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Urology, Sao Paulo, Sao Paulo, BR
| | - Carolyn Salter
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Jose Flores
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
- Universidade Federal do Ceara, Division of Urology, Fortaleza, BR
| | - Jean Terrier
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Hisanori Taniguchi
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Lawrence Jenkins
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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18
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Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, Morel Journel N, Beley S, Graziana JP, Marcelli F, Hupertan V, Yiou R, Ben-Naoum K, Savareux L, Huyghe E, Faix A. [French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. Prog Urol 2021; 31:477-494. [PMID: 33941460 DOI: 10.1016/j.purol.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
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Affiliation(s)
- L Ferretti
- Service d'urologie, MSP Bordeaux Bagatelle, Talence.
| | - F-X Madec
- Service d'urologie, hôpital Foch, Suresnes
| | - W Akakpo
- Département d'urologie, Hôpital Pitié-Salpétrière, Paris
| | - C Methorst
- Service d'urologie, hôpital des 4 Villes, Saint-Cloud
| | - D Carnicelli
- Service d'urologie, hôpital Privé Jean Mermoz, Lyon
| | - J-E Terrier
- Service d'urologie, Hôpital Lyon Sud, Pierre-Bénite
| | | | | | - J-P Graziana
- Clinique Mutualiste de la Porte de l'Orient, Lorient
| | - F Marcelli
- Service d'urologie, andrologie et transplantation rénale, hôpital Huriez CHU Lille, France
| | | | - R Yiou
- Département d'urologie, CHU Henri Mondor, Créteil
| | | | - L Savareux
- Service d'urologie, Hôpital Privé la Chataigneraie, Beaumont
| | - E Huyghe
- Département d'urologie, CHU Rangueil, Toulouse
| | - A Faix
- Centre d'urologie du Polygone, Montpellier
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19
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Ragheb A, Eraky A, Osmonov D. A decade of grafting techniques as a sole treatment for Peyronie's disease. Andrology 2020; 8:1651-1659. [PMID: 32623827 DOI: 10.1111/andr.12857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/27/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peyronie's disease (PD) can be a cosmetically and functionally devastating condition. Surgical approaches have been proposed in the chronic stages of PD as plication or plaque incision/excision with grafting to preserve penile size in complex cases. Although several surgeons nowadays are inclined toward the utilization of non-autologous grafts owing to the ease of their preparation and availability, synthetic graft procedures still await more technical improvements and supporting evidence before their consideration for standard care. OBJECTIVES In this review, our goal is to facilitate an insight into the most promising grafting materials used for the management of PD and techniques associated. MATERIALS AND METHODS A PubMed review was conducted for all the studies on our topic within the past ten years (January 2009 until December 2019). The outcome parameters we documented and compared comprised of operative time, follow-up time, postoperative penile cosmesis and function, and, finally, overall patient satisfaction related to each technique. RESULTS Our search yielded 23 English-written original study articles in addition to a single case report on the various grafting techniques utilized as the sole treatment for PD, each demonstrating different outcomes and points of comparison. CONCLUSION A successful grafting procedure for PD requires an appropriately tailored surgical modality and an experienced surgeon. Nevertheless, proper preoperative patient counseling on all aspects of his condition and opted treatment modality while setting clear and realistic expectations remains key for overall patient satisfaction.
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Affiliation(s)
- Ahmed Ragheb
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany.,Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Eraky
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany
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20
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Sperling H. [Reconstructive possibilities for Peyronie's disease]. Urologe A 2020; 59:426-431. [PMID: 32140745 DOI: 10.1007/s00120-020-01154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The surgical treatment of Peyronie's disease involves a multistage procedure with increasing invasiveness. In addition to precise knowledge about the existing surgical treatment procedures, the indication and the informed consent process of the patient is extremely important. The dissatisfaction with the surgical results for many patients is due to false expectations and positivistic representations. If we can avoid this and make the right decisions during surgery, even these difficult-to-treat patients can be treated successfully.
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Affiliation(s)
- Herbert Sperling
- Urologische Klinik, Kliniken Maria Hilf GmbH, Viersener Str. 450, 41063, Mönchengladbach, Deutschland.
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21
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Gamidov S, Shatylko T, Gasanov N, Scherbakov D, Li K, Sukhikh G. Long-term outcomes of surgery for Peyronie's disease: focus on patient satisfaction. Int J Impot Res 2020; 33:332-338. [PMID: 32366986 DOI: 10.1038/s41443-020-0297-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 11/09/2022]
Abstract
Immediate outcomes of surgery for Peyronie's disease (PD) are fairly easy to analyze. However, it is the patient-reported long-term outcomes which eventually determine the success of PD treatment. The goal of this observational study was to evaluate patients' satisfaction with results of surgical treatment for PD at long-term follow-up. The primary outcome was the proportion of patients who were completely satisfied with their erectile function and penile appearance. We retrospectively identified 374 patients who underwent surgery for PD (median follow-up: 9.5 years) and attempted to invite them for follow-up visit; 342 patients were available for follow-up. Only 285 (83.3%) were sexually active. Among all patients, 197 (57.6%) were completely satisfied with penile appearance; among sexually active patients, 139 (40.6%) were completely satisfied with their erections. Only 101 patients (29.5%) were completely satisfied with penile appearance and erectile function. Logistic regression analysis revealed preoperative IIEF-EF score (OR = 1.668 per 1 point; 95% CI 1.469-1.894), tunica albuginea plication (OR = 5.599; 95% CI = 1.014-30.92), use of saphenous vein (OR = 8.517; 95% CI = 2.491-29.115), and cadaveric pericardium (OR = 61.388; 95% CI = 7.674-491.11) as significant predictors of satisfaction with erectile function. Severity of curvature (OR = 0.926 per 5°; 95% CI = 0.907-0.946) and tunica plication (OR = 0.117; 95% CI = 0.019-0.738) were negative predictors of satisfaction with penile appearance. Preoperative IIEF-EF (OR = 1.497 per 1 point; 95% CI = 1.322-1.694), severity of penile curvature (OR = 0.967 per 5°; 95% CI = 0.95-0.983), and use of pericardium allograft (OR = 10.728; 95% CI = 1.363-84.46) were predictors of both endpoints (satisfaction with erectile function and cosmesis). Despite excellent surgical outcomes in PD, patients' satisfaction with penile appearance and erectile function is far from absolute and depends on many patient-related and treatment-related factors.
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Affiliation(s)
- Safar Gamidov
- Sechenov University, Moscow, Russia.,V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Taras Shatylko
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia.
| | - Natig Gasanov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Dmitriy Scherbakov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Konstantin Li
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Gennadiy Sukhikh
- Sechenov University, Moscow, Russia.,V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
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22
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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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23
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DiGiorgio L, Mendez M, Parker J, Carrion R. Surgical Techniques and Pitfalls for Excision and Grafting. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Walker DT, Amighi A, Mills SA, Eleswarapu SV, Mills JN. Management of the Acute Phase of Peyronie’s Disease: a Contemporary Review. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Strategies and current practices for penile lengthening in severe Peyronie's disease cases: a systematic review. Int J Impot Res 2019; 32:52-63. [PMID: 31481708 DOI: 10.1038/s41443-019-0189-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023]
Abstract
Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile function, plaque incision/excision (PIG/PEG) are advisable in order to maximize penile length, despite the risk of postoperative erectile dysfunction (ED), recurrent curvature, or penile shortening. For men with PD deformities associated to a certain degree of ED several lengthening techniques associated to penile prosthesis (PPI) implantation can be considered. Because of the potential postoperative complications, the indication must be balanced between patient's risk factors and surgeon's experience. Furthermore, adjuvant surgeries, such as prepubic V-Y plasty, suspensory ligament release, suprapubic lipectomy, and ventral phalloplasty, can be performed simultaneously or in a staged fashion to maximize the outcomes. Restoration a decent penile length in the case of a severe PD represents a real challenge for reconstructive surgeons. We present a systematic review of the literature on the current practices for penile lengthening in severe PD, providing the reader with a practical overview on the existing surgical strategies and their surgical and functional outcomes.
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26
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Hatzichristodoulou G. Novel approaches and new grafting materials in Peyronie’s disease reconstructive surgery. Int J Impot Res 2019; 32:37-42. [DOI: 10.1038/s41443-019-0179-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/02/2019] [Indexed: 01/06/2023]
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27
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Soave A, Laurich S, Dahlem R, Vetterlein MW, Engel O, Nieder T, Briken P, Rink M, Fisch M, Reiss P. Negative Self-Perception and Self-Attitude of Sexuality Is a Risk Factor for Patient Dissatisfaction Following Penile Surgery with Small Intestinal Submucosa Grafting for the Treatment of Severe Peyronie's Disease. J Clin Med 2019; 8:E1121. [PMID: 31357703 PMCID: PMC6722693 DOI: 10.3390/jcm8081121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess patient satisfaction with surgical outcome, body related self-perceptions, self-attitudes of sexuality, and health related quality of life after penile surgery with small intestinal submucosa (SIS) grafting for the treatment of severe Peyronie's disease (PD). MATERIAL AND METHODS This retrospective study included 82 patients, who were treated with SIS grafting for severe PD between 2009 and 2013 at the University Medical Center Hamburg-Eppendorf. Patients were asked to complete standardized questionnaires including the International Index of Erectile Function Erectile Function domain (IIEF-EF), Short-Form (SF)-8 Health Survey, and Frankfurt Body Concept Scale-Sexuality (FKKS-SEX). RESULTS Follow-up was available in 58 (69.9%) patients. SIS grafting resulted in subjective straightening of the penis in 53 (91.3%) patients. After a mean follow-up of 28.9 ± 16.5 months, 24 (41.4%) patients were satisfied or very satisfied with surgical outcome. Postoperatively, the mean FKKS-SEX was 23.5 ± 5.9. In total, 36 (62.1%), 18 (31%), and four (6.9%) patients had FKKS-SEX scores corresponding to positive, neutral, and negative self-perception and self-attitude of sexuality, respectively. The mean postoperative SF-8 was 15.2 ± 6.4. Compared to the mean for German controls, patients achieved lower mean scores in the domains social functioning (50.4 ± 7.1), mental health (49.5 ± 9.2), and emotional roles (48.5 ± 6.8). Subjective shortening of the penis (Odds ratio (OR): 2.0), negative body related self-perceptions, and self-attitudes of sexuality (OR: 3.6) as well as IIEF-EF score (OR: 0.9) were risk factors for patient dissatisfaction (p-values ≤ 0.02). CONCLUSION A relevant number of patients is not satisfied with surgical outcome after SIS grafting for the treatment of severe PD. Subjective shortening of the penis, negative body related self-perceptions, and self-attitudes of sexuality as well as IIEF-EF score were risk factors for patient dissatisfaction.
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Affiliation(s)
- Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sebastian Laurich
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Timo Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Philip Reiss
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Twenty Years of Plaque Incision and Grafting for Peyronie's Disease: A Review of Literature. Sex Med 2019; 7:115-128. [PMID: 30890446 PMCID: PMC6523061 DOI: 10.1016/j.esxm.2019.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature and, despite a multitude of incision types and grafting materials having been used, no individual technique has proven superiority. Aim To assess outcomes following PIG and to understand the operative technique. Methods A systematic review was performed to find all relevant studies reporting on use of the PIG technique to correct curvature resulting from Peyronie’s disease. Studies were included if they had >40 participants, were written in the English language, and no penile prosthesis was implanted. Main Outcome Measures Primary outcome measures included deformity correction, erectile dysfunction, and degree of penile lengthening/shortening. Secondary outcome measures included satisfaction, reoperation rate, and complications. Results Twelve studies were included in the quantitative synthesis, which overall report on the results of 1,025 patients. Careful patient selection was critical, with erectile function requiring assessment with the International Index of Erectile Function (IIEF), subjective patient reports, and consideration of whether erections are pharmacologically aided. There was no evidence of superiority in favor of any particular incision type or grafting material, and absorbable sutures were clearly favored. Postoperatively, 4.6%–67.4% required pharmacologically aided erections and 0–11.8% were completely unable to achieve erections. Successful straightening occurred in 80.0%–96.4%, although there was no consistent definition of success. Penile length was unchanged in 44.2%–95.0%; 88.0%–92.0% of the patients were satisfied, and .7%–4.7% required reoperation. Altered sensation occurred in 2.0%–22.5% of patients, of which 80.0%–100.0% was only a transient loss. All outcomes were heterogeneously reported. There are no clear predictive factors for erectile dysfunction following PIG surgery. No single incision type or grafting material has proven superiority. Conclusion PIG is an effective and safe technique for correction of complex or severe penile curvature in terms of satisfaction, length change, straightening, and complications. Rice PG, Somani BK, Rees RW. Twenty Years of Plaque Incision and Grafting for Peyronie’s Disease: A Review of Literature. Sex Med 2019;7:115–128.
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Randhawa K, Shukla CJ. Non-invasive treatment in the management of Peyronie's disease. Ther Adv Urol 2019; 11:1756287218823671. [PMID: 30792820 PMCID: PMC6376494 DOI: 10.1177/1756287218823671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
Peyronies disease (PD) is estimated to affect approximately 3-9% of men worldwide and maybe associated with pain, erectile dysfunction and penile deformity including shortening. The condition has significant debilitating effects on quality of life, self-esteem and psychological wellbeing in addition to sexual function. Surgical results add further to this by patients having dissatisfaction with various aspects of outcomes. Non-surgical management may allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. Several non-surgical options are currently being employed in the treatment of PD that may reduce or stabilize both objective measures (e.g. penile length and deformity) and subjective measures (including sexual function, pain and partner satisfaction). Nonsurgical management can allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. In this article we explore the current non-surgical management options for PD including oral, mechanical therapies, intralesional and topical treatments. We also briefly discuss future treatment options in the form of stem cell therapy.
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Affiliation(s)
| | - C. J. Shukla
- Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie's disease: a matched pair analysis. Int J Impot Res 2018; 31:256-262. [DOI: 10.1038/s41443-018-0071-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/03/2018] [Accepted: 08/20/2018] [Indexed: 12/19/2022]
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Terrier JE, Tal R, Nelson CJ, Mulhall JP. Penile Sensory Changes After Plaque Incision and Grafting Surgery for Peyronie's Disease. J Sex Med 2018; 15:1491-1497. [PMID: 30195564 DOI: 10.1016/j.jsxm.2018.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 06/11/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes. AIM To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such. METHODS The study population consisted of patients with PD-associated penile curvature who underwent PIG surgery with at least 6 months of follow-up. Demographics and PD factors were recorded. Patient had preoperative assessment of penile sensation and deformity. Postoperative follow-up occurred at 1 week, 1 month, 6 months, and 1 year after surgery. Neurovascular bundle elevation was conducted with loupe magnification. MAIN OUTCOME MEASURE Penile sensation was evaluated with a biothesiometer and graded on a patient-reported visual analog scale (0-10) in which 0 defined a completely numb area and 10 defined perfect sensation. The degree of sensation loss was defined as extensive (any 1 area >5 cm), major (2-5 cm), and minor (≤2 cm). The penile sensation loss distribution was defined as focal (1 site) or diffuse (>1 site). RESULTS 63 patients were analyzed. Mean age was 56 ± 10 years. Mean duration of PD at the time of PIG was 15 ± 7 (12-38) months. 75% had curvature alone, and 25% had hourglass/indentation deformities. Mean primary curvature was 64˚ ± 28˚. The mean operation duration was 3.5 ± 1.8 hours. 21% had some degree of sensation loss at 1 week, 21% at 1 month, 8% at 6 months, and 3% at 12 months. Only 1 patient (1.5%) at 2 years continued to have extensive sensation loss on the glans and distal shaft with a very elevated sensitivity threshold. Using multivariable analysis, the only predictor of penile sensation loss ≥6 months was a duration of operation >4 hours (odds ratio = 2.1; 95% confidence interval = 1.2-3.0; P < .01). CLINICAL IMPLICATIONS The study highlights the need during patient consent to discuss penile sensation loss. Patients should be informed that rates of penile sensation loss ranges from 2-30% and most patients will have complete resolution of any sensation loss within one year of follow-up. STRENGTH AND LIMITATIONS To our knowledge no other studies have described the chronology and severity of penile sensation following PIG, our study demonstrates the utility of biothesiometry in measuring penile sensation before and after PIG. Number of patients and absence of control group represent a limitation. CONCLUSION Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring >12 months. Longer operations appeared to be more likely associated with sensation loss. Terrier JE, Tal R, Nelson CJ. Penile sensory changes after plaque incision and grafting surgery for Peyronie's disease. J Sex Med 2018;15:1491-1497.
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Affiliation(s)
- Jean E Terrier
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Raanan Tal
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Morgado A, Morgado MR, Tomada N. Penile lengthening with porcine small intestinal submucosa grafting in Peyronie's disease treatment: long-term surgical outcomes, patients’ satisfaction and dissatisfaction predictors. Andrology 2018; 6:909-915. [DOI: 10.1111/andr.12522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/25/2022]
Affiliation(s)
- A. Morgado
- Serviço de Urologia; Centro Hospitalar São João; Porto Portugal
- Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - M. R. Morgado
- Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - N. Tomada
- Nuno Tomada Urologia e Cirurgia Reconstrutiva; Porto Portugal
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Wayne GF, Cordon BH. Contemporary surgical and non-surgical management of Peyronie's disease. Transl Androl Urol 2018; 7:603-617. [PMID: 30211050 PMCID: PMC6127552 DOI: 10.21037/tau.2018.04.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 12/11/2022] Open
Abstract
Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.
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Affiliation(s)
- George F. Wayne
- Mount Sinai Medical Center Division of Urology, Miami Beach, FL, USA
| | - Billy H. Cordon
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami Beach, FL, USA
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Antonini G, De Berardinis E, Del Giudice F, Busetto GM, Lauretti S, Fragas R, Chung BI, Conti SL, Giannarelli D, Sperduti I, Gross MS, Perito PE. Inflatable Penile Prosthesis Placement, Scratch Technique and Postoperative Vacuum Therapy as a Combined Approach to Definitive Treatment of Peyronie's Disease. J Urol 2018; 200:642-647. [PMID: 29678456 DOI: 10.1016/j.juro.2018.04.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Peyronie's disease is a devastating condition resulting in penile malformation, erectile dysfunction, pain and emotional distress. In this prospective, 2 institution study we evaluated a multimodal surgical and mechanical combined approach to the definitive treatment of Peyronie's disease and concomitant erectile dysfunction. MATERIALS AND METHODS A total of 145 select patients underwent endocavernous disruption of Peyronie's disease plaques via the scratch technique, followed by inflatable penile prosthesis insertion. Postoperatively patients were assigned to vacuum device therapy for 3 minutes twice daily to continue penile curvature correction. Followup continued for 1 year after surgery. Anatomical and functional results were assessed. RESULTS Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean ± SD postoperative residual curvature of 21.5 ± 4.5, 17.3 ± 4.8 and 14.1 ± 3.1 degrees, respectively. After 24 weeks of vacuum therapy the mean penile curvature deviation decreased to 8.7 ± 2.5, 9.1 ± 2.9 and 7.7 ± 0.9 degrees, respectively. The mean IIEF-5 (International Index of Erectile Function) score was 9.8 ± 2.3 preoperatively, 18.9 ± 3.1 at 6 months (p <0.001) and 24.1 ± 3.6 at 1 year (p <0.001). The mean EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) score at the end of followup was 64.6 ± 11.8. Operative and postoperative complications were minimal. CONCLUSIONS Our novel combination of intraoperative and postoperative therapies in the treatment of patients with Peyronie's disease and an inflatable penile prosthesis was safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.
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Affiliation(s)
- Gabriele Antonini
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Ettore De Berardinis
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Stefano Lauretti
- Department of Urology, Santa Caterina della Rosa Clinic ASL RM-C, Rome, Italy
| | | | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Simon L Conti
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Paul E Perito
- Department of Urology, Coral Gables Hospital, Coral Gables, Florida
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Chung E. Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function. World J Mens Health 2018; 38:1-8. [PMID: 29623703 PMCID: PMC6920076 DOI: 10.5534/wjmh.170056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 01/23/2023] Open
Abstract
To provide an overview of current approaches to penile reconstructive surgery in Peyronie disease (PD), and to discuss the challenges in restoring normal penile size and function. A systematic literature search was conducted to identify the published literature relevant to PD and penile reconstructive surgery. A summary of the published guidelines from major organisations is included in this review paper. Penile plication is simple and minimally invasive, and tends to preserve potency in most patients. However, plication invariably results in penile length loss and may, in fact, worsen the existing hour-glass or hinge effect. In contrast, graft reconstructive surgery can address issues relating to the loss of penile length and complex penile deformities, but long-term data highlight the risks of altered glans sensation, recurrent curvature, and/or loss of penile length from graft contracture, as well as the development of erectile dysfunction. Complex penile reconstruction with the concurrent placement of a penile prosthesis and/or graft material is a demanding operation that should be performed by surgeons with extensive prosthetic and reconstructive experience, as the risk of sensory loss, glans ischemia/necrosis, prosthesis-related complications, and failure to gain any meaningful length are serious concerns and cannot be underestimated. While surgical approaches remain the standard of care, they pose considerable risks and require prolonged postoperative rehabilitation. Obtaining proper informed consent and establishing realistic outcome expectations are imperative for successful postoperative outcomes.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital and University of Queensland, Brisbane, Australia.,AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, Australia.
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Reed-Maldonado AB, Alwaal A, Lue TF. The extra-tunical grafting procedure for Peyronie's disease hourglass and indent deformities. Transl Androl Urol 2018; 7:S1-S6. [PMID: 29644164 PMCID: PMC5881200 DOI: 10.21037/tau.2017.12.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To describe a novel, tunica-sparing surgical technique—extra-tunical grafting (ETG)—for the treatment of penile indent and hourglass (HG) deformities and to describe patient-reported outcomes after the ETG procedure. Methods An IRB-approved, retrospective chart review of ETG patients was performed to collect data including pre-operative deformity, operation performed, and post-operative patient-reported perception of deformity, erectile function, penile sensation, and overall satisfaction with the ETG operation. The indications for surgery were difficulty with sexual intercourse due to deformity and/or poor cosmesis of the penis. Pre-operatively all patients had erections adequate for intercourse with or without medications. The ETG procedure is performed through a ventral longitudinal penile skin incision. The dissection is continued to the level between Dartos and Bucks fascia, circumferentially for HG deformity and focally for indent deformity. The neurovascular bundle (NVB) is left undisturbed. A cadaveric fascia graft is applied, singly or in multiple layers, to fill the exposed tunical depressions. Our preferred graft material is Tutoplast Suspend® (Coloplast, Minneapolis, MN, USA). The graft is sutured into position with multiple interrupted, long-lasting absorbable sutures to achieve the desired penile shaft contour. The urethra is excluded from the graft. Results From October 2013 to June 2017, 36 patients had the ETG procedure for HG and/or indent with or without penile curvature. Results with a minimum of 6 months of follow-up could be extracted for 18 of the patients. One was excluded as he required concurrent excision of a large calcified tunical plaque, which necessitated incision into the tunica albuginea (TA). Follow-up was between 6 and 44 months (average 21 months). All patients reported satisfactory resolution of the HG or indent. No patient reported worsened erectile function. Two patients (11.8%) reported slight penile hypoesthesia, with one of these having had multiple previous penile degloving surgeries for trauma. Ten of the patients reported being “very satisfied” and six reported being “satisfied” with the procedure. One was neutral. All reported that they would recommend the ETG procedure to a friend, and all would repeat the same surgery again. Conclusions The ETG procedure is a straightforward approach to HG and indent deformities to correct the penile deformity and to provide structural support to prevent penile buckling during intercourse. The procedure does not violate the TA and does not require dissection of the NVB. Thus, ETG carries a very low risk of de novo impotence or hypoesthesia as highlighted by this patient series. With such low risk and high patient-reported satisfaction rates, the ETG procedure is a valuable surgical technique for the treatment of complex penile deformities.
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Affiliation(s)
| | - Amjad Alwaal
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Bella AJ, Lee JC, Grober ED, Carrier S, Benard F, Brock GB. 2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature. Can Urol Assoc J 2018; 12:E197-E209. [PMID: 29792593 DOI: 10.5489/cuaj.5255] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Peyronie’s disease (PD) is a highly prevalent condition that affects the physical and psychosocial well-being and quality of life (QoL) for thousands of Canadian men. The specific etiology of PD remains poorly understood and there remains a paucity of randomized placebo-controlled trials evaluating treatment interventions.1-3 PD can be found in up to 8.9% of men, a remarkable increase in cited prevalence that is attributable to growing awareness (as historical data suggested a rate of less than 1%); the burden of disease is significant, and PD is often present in otherwise healthy men. The following guidelines were crafted by the committee with a full awareness of the limitations of the literature, and sought to provide actionable recommendations to guide PD care in the Canadian health system.
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Affiliation(s)
- Anthony J Bella
- Ottawa Urology and Men's Health and Ottawa Hospital Research Institute, Ottawa ON; Canada
| | - Jay C Lee
- Department of Surgery, Division of Urology, University of Calgary, Calgary, AB; Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON; Canada
| | - Serge Carrier
- Division of Urology, McGill University Health Centre, Montreal, QC; Canada
| | - Francois Benard
- Department of Surgery, Université de Montreal, Montreal, QC; Canada
| | - Gerald B Brock
- Department of Surgery, Division of Urology Western University, London, ON; Canada
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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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Garcia-Gomez B, Ralph D, Levine L, Moncada-Iribarren I, Djinovic R, Albersen M, Garcia-Cruz E, Romero-Otero J. Grafts for Peyronie's disease: a comprehensive review. Andrology 2017; 6:117-126. [DOI: 10.1111/andr.12421] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/17/2017] [Accepted: 08/02/2017] [Indexed: 12/28/2022]
Affiliation(s)
- B. Garcia-Gomez
- Department of Urology; 12 de Octubre University Hospital; Madrid Spain
| | - D. Ralph
- Departments of Urology and Andrology; University College Hospital; London UK
| | - L. Levine
- Department of Urology; Rush University; Chicago IL USA
| | | | | | - M. Albersen
- Department of Urology; University Hospitals Leuven; Leuven Belgium
| | | | - J. Romero-Otero
- Department of Urology; 12 de Octubre University Hospital; Madrid Spain
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Hatzichristodoulou G, Tsambarlis P, Kübler H, Levine LA. Peyronie's graft surgery-tips and tricks from the masters in andrologic surgery. Transl Androl Urol 2017; 6:645-656. [PMID: 28904897 PMCID: PMC5583062 DOI: 10.21037/tau.2017.07.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/07/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Grafting techniques in the surgical management of Peyronie's disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD. METHODS This report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed. RESULTS Adequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy. CONCLUSIONS The present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.
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Affiliation(s)
| | - Peter Tsambarlis
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
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Self-reported Clinical Meaningfulness Early in the Treatment Course Predicts Objective Outcomes in Men Undergoing Collagenase Clostridium histolyticum Injections for Peyronie Disease. Urology 2017; 106:107-112. [DOI: 10.1016/j.urology.2017.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 01/22/2023]
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Silva-Garretón A, Santillán D, Chávez D, Gioielli A, Rey-Valzacchi G, Layús O, Gueglio G. Satisfaction of patients with Peyronie's disease after plaque surgery and bovine pericardium graft. Actas Urol Esp 2017; 41:103-108. [PMID: 27468940 DOI: 10.1016/j.acuro.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Plaque and bovine pericardium graft surgery is a useful tool for treating Peyronie's disease. OBJECTIVE To determine patient satisfaction following this operation. MATERIALS AND METHODS This was a retrospective, observational and descriptive study. We collected data from the medical records of patients who underwent surgery between 2004 and 2015 and were evaluated through a postoperative satisfaction questionnaire. RESULTS Twenty-eight operations were performed. Curve correction was achieved in 26 patients (95.3%). One patient (3.57%) required residual curve correction using Yachia's technique, and 1 patient (3.57%) had a severe complication consisting of prosthetic infection and urethrocutaneous fistulae. Twenty-one patients (75%) expressed satisfaction with the surgery. CONCLUSIONS Our results show an acceptable level of satisfaction among our patients, with a low number of complications. However, further prospective, controlled and randomised studies are needed.
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Affiliation(s)
- A Silva-Garretón
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina.
| | - D Santillán
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - D Chávez
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - A Gioielli
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - G Rey-Valzacchi
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - O Layús
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - G Gueglio
- Departamento de Urología, Sección Andrología, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
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Sayedahmed K, Rosenhammer B, Spachmann PJ, Burger M, Aragona M, Kaftan BT, Olianas R, Fritsche HM. Bicentric prospective evaluation of corporoplasty with porcine small intestinal submucosa (SIS) in patients with severe Peyronie's disease. World J Urol 2016; 35:1119-1124. [PMID: 27864619 DOI: 10.1007/s00345-016-1973-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Advanced Peyronie's disease (PD) with severe penile deviation demands grafting procedures following plaque incision or partial plaque excision in order to avoid penile shortening and to improve quality of life of affected patients. Small intestinal submucosa (SIS) is an established xenograft. The objective of the present study was to validate external results in a bicentric prospective manner. METHODS Patient selection criteria, surgical technique and standards for pre- and postoperative care were defined. Consecutively, patients with severe penile deviation in stable disease and sufficient erectile function were included between 2007 and 2015. After plaque incision, grafting was performed using SIS in a standardized manner. The postoperative evaluation using a non-validated questionnaire included complications, correction of curvature, pre- and postoperative erectile function, change in penile length and general satisfaction with the procedure. RESULTS Forty-three patients underwent surgery between 2007 and 2015. The mean degree of preoperative curvature was 73.8° (range 60-90°). No intraoperative or major postoperative complications were reported. After a mean follow-up of 33.0 months (range 10-59), complete straightening of the penis was achieved in 74.4%. 88.4% of all patients were able to achieve satisfying sexual intercourse (67.4% unaided, 21.0% with assistance). The IIEF-5 score was improved in 69.8% (mean improvement 4.0 points). Overall 86.0% were satisfied with the surgical treatment. CONCLUSION Corporoplasty with SIS in patients with PD and severe penile curvature is a safe approach and shows good long-term results. A thorough patient selection and a standardized pre-, intra- and postoperative procedure are decisive for a satisfying outcome.
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Affiliation(s)
- K Sayedahmed
- Department of Urology, Lueneburg Medical Center, Lueneburg, Germany
- Department of Urology, Menoufia University, Shebeen El-Kom, Egypt
| | - B Rosenhammer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - P J Spachmann
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - M Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - M Aragona
- Department of Urology, Lueneburg Medical Center, Lueneburg, Germany
| | - B T Kaftan
- Department of Urology, Lueneburg Medical Center, Lueneburg, Germany
| | - R Olianas
- Department of Urology, Lueneburg Medical Center, Lueneburg, Germany
| | - H M Fritsche
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany.
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Contemporary Review of Treatment Options for Peyronie's Disease. Urology 2016; 95:16-24. [DOI: 10.1016/j.urology.2016.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
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Vicini P, Di Nicola S, Antonini G, De Berardinis E, Gentile V, De Marco F. Geometrical modified nesbit corporoplasty to correct different types of penile curvature: description of the surgical procedure based on geometrical principles and long-term results. Int J Impot Res 2016; 28:209-215. [DOI: 10.1038/ijir.2016.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/05/2016] [Accepted: 04/24/2016] [Indexed: 02/01/2023]
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Hatzichristodoulou G. Advances in the Surgical Treatment of Peyronie’s Disease. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
Peyronie’s disease (PD) is a benign fibrotic condition of the penile tunica albuginea. PD can be associated with penile pain, curvature, shortening, and erectile dysfunction (ED). The predominant and most bothersome symptom in affected patients is penile curvature, which can lead to inability to have sexual intercourse. In such cases, surgical correction of the curvature may be required. Plication techniques to correct curvature can cause penile shortening and therefore are generally reserved for curvatures <60°. Penile prosthesis implantation with simultaneous correction of curvature by various means is recommended in PD patients with ED not responding to medical therapy. Grafting techniques are the preferred surgical treatment in patients with penile curvatures >60°, short penis, or hourglass deformity. Patients scheduled for grafting surgery are required to have satisfactory erectile rigidity preoperatively. There are various grafting materials that can be used for closure of the tunica albuginea defect following plaque incision/excision. Both autologous and non-autologous grafts have been used for PD reconstructive surgery, and each graft has its advantages and disadvantages. Novel grafting materials are presented and discussed in this review. A major advantage of the available “off-the-shelf” grafts is that there is no harvesting from a donor site and, thus, morbidity is reduced, and operative times are minimized. Further investigations in regard to tissue-engineered grafts to improve surgical handling and postoperative outcomes are ongoing. Surgeon experience, careful patient selection, patient preference and type of penile deformity affect the choice of graft. This review summarizes the literature within the past 5 years regarding grafting techniques in PD. Surgical outcomes and limitations of grafting techniques are reported. A major objective of this review is dedicated to preoperative considerations and indications for grafting procedures, with the aim to improve surgical outcomes and increase patient satisfaction. Proper postoperative management of patients after incision/excision and grafting is important to avoid early and long-term complications and unwanted outcomes. This review provides an overview of recent advances and recommendations in regard to rehabilitation strategies after grafting procedures. Adequate preoperative patient counseling, careful patient selection, appropriate indications, and postoperative management is key to optimal surgical outcomes with high satisfaction rates after grafting techniques in PD surgery.
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Affiliation(s)
- Georgios Hatzichristodoulou
- Department of Urology, Technical University of Munich, University Hospital Klinikum rechts der Isar, Munich, Germany
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Miranda AF, Sampaio FJB. Practical Computerized Solution for Incision and Grafting in Peyronie's Disease. Sex Med 2016; 4:e73-82. [PMID: 26796855 PMCID: PMC5005311 DOI: 10.1016/j.esxm.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Penile curvature correction with plaque incision and graft (PIG) increases the risk of erectile dysfunction (ED) and is associated with mechanical and geometric abnormalities. Aims The aim of this study was to create and validate a new PIG technique using minimum graft area to correct simple or complex penile curvature with or without hourglass deformity, while avoiding mechanical and geometric abnormalities. Methods Using our cotton fabric model, we created a mathematic solution for PIG with no residual defects. This was applied in nine men who had sufficient penile rigidity while penetrating their respective partners. They underwent fascia lata patch corporoplasty using the new developed technique (iPad [Apple Corp, Palo Alto, CA, USA] app: iGrafter). Subjects answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire preoperatively and at the end of follow-up. Main Outcome Measures The main outcome measures used were patient demographics, erectile function, residual curvature, patient satisfaction, graft area, and complications. Results After a mean follow-up of 17.8 months, no significant complication was noted. Complete penile straightening was achieved in all patients. The short side of the penis increased a mean of 3 cm in length, and the mean graft area was 12.4 cm2. At the end of the follow-up, three patients developed recurrent deformity. One patient presented severe fibrosis in the corpora cavernosa and severe ED. There was no significant difference between the mean preoperative and postoperative IIEF-5 scores (20.6 vs 19.4, respectively). At the end of follow-up, all patients were able to have sexual intercourse (two with and seven without pharmacological aid). Eight of the nine patients were satisfied with the surgical result. Conclusion Penile curvature surgical correction using the iGrafter seems to be an efficient and safe procedure, which uses minimum graft area and preserves erectile function after penile rectification, without resulting in residual deformities. Further research is needed to confirm the efficacy of this procedure.
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Affiliation(s)
- Alexandre F Miranda
- Ministry of Health, Ipanema Federal Hospital, Rio de Janeiro, Brazil; Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.
| | - Francisco J B Sampaio
- Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
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Garaffa G, Kuehhas FE, De Luca F, Ralph DJ. Long-Term Results of Reconstructive Surgery for Peyronie's Disease. Sex Med Rev 2015; 3:113-121. [PMID: 27784545 DOI: 10.1002/smrj.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Giulio Garaffa
- St. Peter's Andrology and the Institute of UrologyUniversity College London Hospital, LondonUK.
| | - Franklin E Kuehhas
- St. Peter's Andrology and the Institute of UrologyUniversity College London Hospital, LondonUK
| | - Francesco De Luca
- St. Peter's Andrology and the Institute of UrologyUniversity College London Hospital, LondonUK
| | - David J Ralph
- St. Peter's Andrology and the Institute of UrologyUniversity College London Hospital, LondonUK
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Biomaterial Grafting Materials in Peyronie’s Disease. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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