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Surgical decisions in Peyronie’s disease

Abstract

In this review, we examine recent advances assisting surgical decision in Peyronie’s disease. Surgical treatment is indicated in penile deformities that have persisted for at least 6 months and functionally impair or preclude intercourse. Procedures shortening the longer side of the penis are invariably associated with length reduction, which may displease patients, despite penile straightening. Procedures lengthening the shorter side by means of grafting provide the best possible gain from a reconstruction procedure, although they may not restore the penis to its original length. Penile rectification and rigidity are required to achieve complete functional restoration of the penis. Most patients experience associated erectile dysfunction, and penile straightening alone may not be enough to restore complete function. Therefore, in some cases, phosphodiesterase inhibitors, self-injection, or a penile prosthesis may need to be added. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed.

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References and Recommended Reading

  1. Gelbard MK, Dorey F, James K: The natural history of Peyronie’s disease. J Urol 1990, 144:1376–1379.

    PubMed  CAS  Google Scholar 

  2. Montorsi F, Salonia A, Maga T, et al.: Evidence-based assessment of long-term results of plaque incision and vein grafting for Peyronie’s disease. J Urol 2000, 163:1704–1708. This study highlights the need to wait 1 year after disease stabilization to perform surgery. In 6% of cases, relapses occurred 6 months after surgery, suggesting a new Peyronie’s disease episode rather than nonstabilized disease episode.

    PubMed  Article  CAS  Google Scholar 

  3. Usta MF, Bivalacqua TJ, Tokatli Z et al.: Stratification of penile vascular pathologies in patients with Peyronie’s disease and in men with erectile dysfunction according to age: a comparative study. J Urol 2004, 172:259–262. This study highlighted the strong association between Peyronie’s disease and erectile dysfunction.

    PubMed  Article  Google Scholar 

  4. Schaeffer EM, Jarow JP Jr, Vrablic J, Jarow JP: Duplex ultrasonography detects clinically significant anomalies of penile arterial vasculature affecting surgical approach to penile straightening. Urology 2006, 67:166–169. The strong association of vascular anomaly supports the indication of this noninvasive method that is associated with drug-induced erection testing to analyze penile deformity and rigidity. The study provides important clues to prevent postoperative ED.

    PubMed  Article  Google Scholar 

  5. Kendirci M, Nowfar S, Gur S, et al.: The relationship between the type of penile abnor-mality and penile vascular status in patients with Peyronie’s Disease. J Urol 2005, 174:632–635.

    PubMed  Article  Google Scholar 

  6. Usta MF, Bivalacqua TJ, Sanabria J, et al.: Patient and partner satisfaction and long-term results after surgical treatment for Peyronie’s disease. Urology 2003, 62:105–109. A relevant study highlighting no increase in complication rates when using reconstruction with pericardial grafting concomitantly with penile prosthesis implantation.

    PubMed  Article  Google Scholar 

  7. Levine LA, Lenting EL: A surgical algorithm for the treatment of Peyronie’s disease. J Urol 1997, 158:2149–2152. Highlighted the importance of subjective rigidity evaluation as reported by the patient and its correlation to objective rigidity as assessed by the physician.

    PubMed  Article  CAS  Google Scholar 

  8. Tornehl CK, Carson CC: Surgical alternatives for treating Peyronie’s disease. BJU Int 2004, 94:774–783. An extensive review of surgical procedures for Peyronie’s disease.

    PubMed  Article  Google Scholar 

  9. Tornehl CK, Carson CC: Surgical treatment of Peyronie’s disease. Urol Clin N Am 2005, 32:479–485. Another extensive review of surgical procedures for Peyronie’s disease.

    Article  Google Scholar 

  10. Mulhall J, Anderson M, Parker M: A surgical algorithm for men with combined Peyronie’s disease and erectile dysfunction: functional and satisfaction outcomes. J Sex Med 2005, 2:132–138. A contribution toward an improved definition of preoperative parameters for the best choice of surgical procedure.

    PubMed  Article  Google Scholar 

  11. Mulhall J, Ahmed A, Anderson M: Penile prosthesis surgery for Peyronie’s disease: Defining the need for intra-operative adjuvant maneuvers. J Sex Med 2004, 1:318–321. A contribution toward assessing the need for adjuvant procedures in cases of PD and penile prosthesis implantation. Surgeons should be familiar with all these associated procedures.

    PubMed  Article  Google Scholar 

  12. Wessells H, Lue TF, McAninch JW: Penile length in the flaccid and erect states: guide-lines for penile augmentation. J Urol 1996, 156:995–997.

    PubMed  Article  CAS  Google Scholar 

  13. Lue TF, El-Sakka Al: Lengthening shortened penis caused by Peyronie’s disease using circular venous grafting and daily stretching with a vacuum erection device. J Urol 1999, 161:1141–1144.

    PubMed  Article  CAS  Google Scholar 

  14. Wilson SK, Delk JR: A new treatment for Peyronie’s disease: modeling the penis over an inflatable prosthesis. J Urol 1994, 152:1121–1123.

    PubMed  CAS  Google Scholar 

  15. Greenfield JM, Lucas S, Levine LA: Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol 2006, 175:238–241. This study showed that the length change correlated significantly with preoperative stretched penis length and the severity of curvature as measured in degrees in the operating room at time of surgery.

    PubMed  Article  Google Scholar 

  16. Gholami SS, Lue TF: Correction of penile curvature using the 16-dot plication tech-nique: a review of 132 patients. J Urol 2002, 167:2066–2069. Suture threads used for this technique must be nonabsorbable, preferably not producing palpable stitches that may cause pain and impact the patient’s quality of life.

    PubMed  Article  Google Scholar 

  17. Van der Horst C, Martinez-Portillo FJ, Melchior D, et al.: Polytetrafluoroethylene versus polypropylene sutures for Essed-Schroeder tunical plication. J Urol 2003, 170:472–475. This study highlights the greatly improved quality of life for patients with minimized stitch palpability and local pain.

    PubMed  Article  Google Scholar 

  18. Giammusso B, Burrello M, Branchina A, et al.: Modified corporoplasty for ventral penile curvature: Description of the technique and initial results. J Urol 2004, 171:1209–1211. This study highlights the simplified technique for ventral curvature correction without vasculonervous bundle mobilization. The authors recommend not using incisions greater than 1.5 cm, even if multiple incisions are necessary, to prevent excessive penile indentation and palpable dog ears.

    PubMed  Article  Google Scholar 

  19. Bokarica P, Parazajder J, Mazuran B, Gilja I: Surgical treatment of Peyronie’s disease based on penile length and degree of curvature. Int J Impot Res 2005, 17:170–174. This study points to the importance of preoperative penile length and curvature degree assessment for selecting surgical treatment. It must be emphasized that even patients with a penis longer than 13 cm may not accept the size reduction imposed by the disease and the surgical procedure. Such patients are candidates for grafting procedures.

    PubMed  Article  CAS  Google Scholar 

  20. Pryor J, Akkus E, Alter G, et al.: Peyronie’s Disease. J Sex Med 2004, 1:110–115. This article contains recommendations from the International Consultation, Paris, 2004.

    PubMed  Article  Google Scholar 

  21. Kalsi J, Minhas S, Christopher N, Ralph D: The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie’s disease. BJU Int 2005, 95:1029–1033.

    PubMed  Article  Google Scholar 

  22. Gelbard MK: Relaxing incisions in the correction of penile deformity due to Peyronie’s disease. J Urol 1995, 154:1457–1460.

    PubMed  Article  CAS  Google Scholar 

  23. Lue TF, El-Sakka Al: Venous patch graft for Peyronie’s disease. Part I. Technique. J Urol 1998, 160:2047–2049. This is an important contribution for tunica incision and grafting.

    PubMed  Article  CAS  Google Scholar 

  24. Egydio PH, Lucon AM, Arap S: A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles. BJU Int 2004, 94:1147–1157. A contribution toward determining the best location of a relaxation incision by means of geometric principles.

    PubMed  Article  Google Scholar 

  25. Perovic SV, Djordjevic ML: The penile disassembly technique in the surgical treat-ment of Peyronie’s disease. BJU Int 2001, 88:731–738. An important contribution on when improved distal exposure is necessary for reconstruction.

    PubMed  Article  CAS  Google Scholar 

  26. Kendirci M, Hellstrom WJG: Critical analysis of surgery for Peyronie’s disease. Curr Opin Urol 2004, 14:381–388. This is an excellent review with critical analysis of PD surgery.

    PubMed  Article  Google Scholar 

  27. Hellstrom WJ, Reddy S: Application of pericardium graft in the surgical management of Peyronie’s disease. J Urol 2000, 163:1445–1447.

    PubMed  Article  CAS  Google Scholar 

  28. Chun JL, McGregor A, Krishnan R, Carson CC: A comparison of dermal and ca-daveric pericardial grafts in the Modified Horton-Devine procedure for Peyronie’s disease. J Urol 2001, 166:185–188.

    PubMed  Article  CAS  Google Scholar 

  29. Levine LA, Estrada CR: Human cadaveric pericardial graft for the surgical correction of Peyronie’s disease. J Urol 2003, 170:2359–2362. This is an excellent discussion of "off-the-shelf"grafting materials.

    PubMed  Article  Google Scholar 

  30. Leungwattanakij S, Bivalacqua TJ, Yang SY, et al.: Comparison of cadaveric pericardial, dermal, vein, and synthetic grafts for tunica albuginea substitution using a rat model. BJU Int 2003, 92:119–124. This study further supports the safety of pericardial graft use.

    PubMed  Article  CAS  Google Scholar 

  31. Knoll LD: Use of porcine small intestinal submucosa graft in the surgical management of Peyronie’s disease. Urology 2001, 57:753–757.

    PubMed  Article  CAS  Google Scholar 

  32. Schultheiss D, Lorenz RR, Meister R, et al.: Functional tissue engineering of autologous tunica albuginea: a possible graft for Peyronie’s disease surgery. Eur Urol 2004, 45:781–786.

    PubMed  Article  Google Scholar 

  33. Eberli D, Susaeta RA, Yoo JJ, Atala A: Novel acellular collagen matrix for Peyronie’s repair. J Urol 2005, 173(Suppl):254.

    Google Scholar 

  34. Egydio PH, Lucon AM, Arap S: Treatment of Peyronie’s disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft. Urology 2002, 59:570–574.

    PubMed  Article  Google Scholar 

  35. Mulcahy JJ, Wilson SK: Management of Peyronie’s disease with penile prostheses. Int J Impot Res 2002, 14:384–388. The procedure most associated with PD surgery and penile prosthesis implantation is reviewed.

    PubMed  Article  CAS  Google Scholar 

  36. Rahman NU, Carrion RE, Bochinski D, Lue TF: Combined penile plication surgery and insertion of penile prosthesis for severe penile curvature and erectile dysfunction. J Urol 2004, 171:2346–2349.

    PubMed  Article  Google Scholar 

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Correspondence to Paulo H. Egydio MD, PhD.

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Egydio, P.H., Srougi, M. Surgical decisions in Peyronie’s disease. Current Sexual Health Reports 3, 69–75 (2006). https://doi.org/10.1007/s11930-996-0005-7

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  • DOI: https://doi.org/10.1007/s11930-996-0005-7

Keywords

  • Erectile Dysfunction
  • Premature Ejaculation
  • Tunica Albuginea
  • Penile Prosthesis
  • Penile Length