madman
Super Moderator
ABSTRACT
Introduction: Peyronie’s disease results in penile curvature, shortening, instability, or pain upon erection—hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment.
Objective: To present an organized description of the most common surgical techniques used in the correction of Peyronie’s disease and to propose a surgical algorithm to guide management.
Methods: Using PubMed, we reviewed the published literature regarding the surgical treatment of Peyronie’s disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes.
Results: Peyronie’s disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management.
Conclusion: Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises if the patient’s erectile function is adequate. The presence of “borderline” erectile function and/ or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie’s disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important.
INTRODUCTION
Peyronie’s disease (PD) is a wound-healing disorder of the albuginea of the corpora cavernosa, leading to a scar. This results in acquired penile curvature, shortening, instability, or pain upon erection, thus hindering sexual performance. It has a prevalence of up to 7.1% in the male general population and is likely underreported because of embarrassment and misconceptions about the available treatment options.1 The impact on the psychological well-being of those affected can be severe, with approximately 50% of patients reporting depressive symptoms and 80% reported distress related to the disease.2 PD is associated with erectile dysfunction (ED) in up to 58% of cases and is often a concomitant diagnosis during investigations for ED.3 The disease has an inflammatory phase followed by a chronic phase. The inflammatory or active phase is characterized by penile pain, frequently during erection, and progressive curvature of the penis. A plaque may be felt more commonly on the concave side of the curvature, that is, sometimes tender. The duration of this phase is variable but can last up to 12 to 18 months. The chronic, or stable phase, then starts, during which the curvature and plaque are stable, and the pain typically disappears.4 “Torque” pain may, however, still be felt on the plaque upon rigid erections.5 Plaque calcification is frequently used as a surrogate for disease stability, but it can happen very early in the course of the illness and should be interpreted with caution.6 It was previously thought that the natural history of PD was one of gradual resolution.7 However, only 12% of the men presenting with PD show some degree of spontaneous improvement in curvature during the course of the disease.
Despite extensive research and accumulated knowledge, the precise pathophysiology still eludes the scientific community, and effective non-surgical management options are lacking, making surgery the mainstay of treatment.8
PATIENT EVALUATION
SURGICAL TECHNIQUES
Corporoplasty
*CONVEX SIDE SHORTENING TECHNIQUES
Excisional Corporoplasty
Incisional Corporoplasty
Plication-Only Corporoplasty
*CONCAVE SIDE LENGTHENING TECHNIQUES
Excision/Incision Techniques
Graft Choice
*PENILE PROSTHESIS IMPLANTATION
No further maneuvers
Modeling
Plication
Incision with or without grafting
Figure 5 presents a suggested step-by-step algorithm for selecting the appropriate surgical technique. Whatever the technique is chosen, obtaining signed informed consent after a meticulous discussion with the patient over the objectives, expected outcomes, and possible complications is essential. It must be made clear to the patient that his penis will not be returned to its state before the onset of disease because PD causes irreversible changes. The aim of the surgery is to restore function. Addressing expectations is critical in the management of PD to achieve patient satisfaction.
Introduction: Peyronie’s disease results in penile curvature, shortening, instability, or pain upon erection—hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment.
Objective: To present an organized description of the most common surgical techniques used in the correction of Peyronie’s disease and to propose a surgical algorithm to guide management.
Methods: Using PubMed, we reviewed the published literature regarding the surgical treatment of Peyronie’s disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes.
Results: Peyronie’s disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management.
Conclusion: Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises if the patient’s erectile function is adequate. The presence of “borderline” erectile function and/ or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie’s disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important.
INTRODUCTION
Peyronie’s disease (PD) is a wound-healing disorder of the albuginea of the corpora cavernosa, leading to a scar. This results in acquired penile curvature, shortening, instability, or pain upon erection, thus hindering sexual performance. It has a prevalence of up to 7.1% in the male general population and is likely underreported because of embarrassment and misconceptions about the available treatment options.1 The impact on the psychological well-being of those affected can be severe, with approximately 50% of patients reporting depressive symptoms and 80% reported distress related to the disease.2 PD is associated with erectile dysfunction (ED) in up to 58% of cases and is often a concomitant diagnosis during investigations for ED.3 The disease has an inflammatory phase followed by a chronic phase. The inflammatory or active phase is characterized by penile pain, frequently during erection, and progressive curvature of the penis. A plaque may be felt more commonly on the concave side of the curvature, that is, sometimes tender. The duration of this phase is variable but can last up to 12 to 18 months. The chronic, or stable phase, then starts, during which the curvature and plaque are stable, and the pain typically disappears.4 “Torque” pain may, however, still be felt on the plaque upon rigid erections.5 Plaque calcification is frequently used as a surrogate for disease stability, but it can happen very early in the course of the illness and should be interpreted with caution.6 It was previously thought that the natural history of PD was one of gradual resolution.7 However, only 12% of the men presenting with PD show some degree of spontaneous improvement in curvature during the course of the disease.
Despite extensive research and accumulated knowledge, the precise pathophysiology still eludes the scientific community, and effective non-surgical management options are lacking, making surgery the mainstay of treatment.8
PATIENT EVALUATION
SURGICAL TECHNIQUES
Corporoplasty
*CONVEX SIDE SHORTENING TECHNIQUES
Excisional Corporoplasty
Incisional Corporoplasty
Plication-Only Corporoplasty
*CONCAVE SIDE LENGTHENING TECHNIQUES
Excision/Incision Techniques
Graft Choice
*PENILE PROSTHESIS IMPLANTATION
No further maneuvers
Modeling
Plication
Incision with or without grafting
Figure 5 presents a suggested step-by-step algorithm for selecting the appropriate surgical technique. Whatever the technique is chosen, obtaining signed informed consent after a meticulous discussion with the patient over the objectives, expected outcomes, and possible complications is essential. It must be made clear to the patient that his penis will not be returned to its state before the onset of disease because PD causes irreversible changes. The aim of the surgery is to restore function. Addressing expectations is critical in the management of PD to achieve patient satisfaction.
