Surgery for Peyronie＇s disease

Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.

Surgical treatment of Peyronie＇s disease： choosing the best approach to improve patient satisfaction

Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.

A self-reported long-term follow-up of patients operated with either shortening techniques or a TachoSil grafting procedure

The aim of this article is to analyse the long-term results of different surgical techniques for correction of penile deviations in Peyronie＇s disease. Patients who underwent surgery for a penile deviation in Peyronie＇s disease between 1997 and 2007 were included into this study. Cases were retrospectively analysed by chart review. The current situation was evaluated by a 16-item standardized questionnaire addressing penile straightness, sensation, length, sexual function and satisfaction. Ninety patients were contacted with a return rate of 75 （83%） evaluabie questionnaires. Thirty-two patients were operated by shortening techniques （STs） with either Schroeder-Essed （n= 16） or Nesbit （n= 16）. Forty-three were operated by a plaque in-lexcision and defect covering by TachoSil method （TM）. Both groups were similar regarding age （ST 56 years, TM 57 years）, comorbidities, mean preoperative erection hardness score （EHS; 3.1 ST, 3.4 TM） and time of follow-up （total mean, 63 months）. Preoperatively ST patients had significantly less plaques （P〈0.05） and a lower deviation angle in comparison to TM patients （ST 56° versus TM 74°; P〈 0.001）. Still TM patients reported slightly better straightening results, but a significantly lower mean EHS （ST 3.3 versus TM 2.6; P〈0.001） during the follow-up. Satisfaction rates were similar in both groups. In conclusion, both techniques revealed to be safe and sustainable successful in penile straightening with better functional outcome of patients operated by STs.