Peyronie's Disease: Surgical Technique Improves Outcomes

Ricki Lewis, PhD

December 29, 2015

The "sliding" technique of penile length restoration, combined with a penile prosthesis implant, can help some patients who have penile deformity and shortness resulting from Peyronie's disease (PD), according to results of a study published online December 21 in BJU International.

PD is an acquired condition in which scar tissue buildup in the tunica albuginea impairs erection, bending and shortening the organ and causing pain, inability to have intercourse, and associated low self-esteem and depression. Risk factors include genetics and penile trauma, and approximately two thirds of patients have one or more major cardiovascular risk factors. The condition tends to worsen.

For patients with refractory erectile dysfunction (ED) or some ED plus a complex deformity and/or short penis, penile prosthesis (PP) implantation is an option, but some procedures can achieve rigidity and straightness but not add length. For some of the 80% of patients with PD who report short penis, penile length restoration along with PP implantation may help extend the organ. One such length restoration procedure is the sliding technique.

Luigi Rolle, MD, from the Department of Urology, University of Turin, Italy, and colleagues conducted a prospective, multicenter study of patients treated with the sliding technique, evaluating surgical outcomes and patients' satisfaction.

From June 2010 to January 2014, 28 consecutive patients with stable PD and severe penile shortening and ED completed three surveys before surgery (the validated International Index of Erectile Function questionnaire, the Sexual Encounter Profile Questions 2 and 3, and the Peyronie's disease questionnaire) at three European PD tertiary referral centers. At postoperative visits (at 3, 6, and 12 months), patients again completed the three questionnaires, plus the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire.

Seven patients received a malleable implanted penile prosthesis that used a collagen-fibrin sponge material to cover defects in the tunica. The other 21 patients received an inflatable implant of three pieces that incorporated small intestinal submucosa and acellular dermal matrix from pigs. Analysis of outcomes considered penile length restoration and complications associated with the surgery. Mean follow-up time was 37 (9 - 60) months.

Operative time was similar in both groups (mean, 115 minutes in the malleable PP group and 145 minutes in the inflatable PP group) with no intraoperative complications or late recurrences of shaft deformation.

Postoperative complications included profuse bleeding requiring a blood transfusion in one patient receiving anticoagulation therapy for a mechanical heart valve, and two infections in patients with diabetes requiring eventual removal of the implant. Postoperative hematoma was common and was managed with elevation and compression.

Questionnaire results indicated progressive improvement in the scores of all questionnaires, peaking at 12 months postoperatively. One patient experienced permanent loss of glans sensation.

"An effective lengthening of the shaft was achieved in all patients," the researchers write. They call for larger series and longer follow-up to fully establish efficacy.

The researchers have disclosed no relevant financial relationships.

BJU Intl. Published online December 21, 2015. Full text


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