Surgery in Peyronie’s Disease: Our Experiences with Tunica Plication, Plaque Incision and Grafting with Gore-Tex, and Satisfaction Degree of the Patients
Journal Title: Archives of Renal Diseases and Management - Year 2015, Vol 1, Issue 1
Abstract
Peyronie’s disease is a relatively common condition, with an incidence of 3-9%. It is often associated with diabetes and erectile dysfunction (ED). This condition causes a penile deformity that can affect sexual penetration and lead to psychological disorders because of the difficulty in coping with the situation. Sometime the surgery does not satisfy the patients; we tried to evaluate this aspect of the disease. Materials and methods: We treated 46 patients for recurvatum penis secondary to Peyronie’s disease. The clinical examination involved an accurate medical history, a physical examination to identify the plaque, ultrasonography to detect calcified plaque, and a photograph of the erect penis to document the recurvatum and sandglass deformity. In the case of ED, we administered the IIEF-5 and performed intracavernous injection of PGE1; in patients eligible for grafting, we also carried out a dynamic echo colour Doppler of the cavernous corps. Penis length, altogether, was between 11.5 and 14.5 cm (13.25 ± 1 cm). In 40 patients with moderate curvature (45-60°) we carried out tunica plication and in 6 cases with curvature >60° and with ED we performed plaque incision and partial dissection, with grafting strips of polyester fluoropolymer (Gore-Tex). In all cases, we performed an extended dissection of the dorsal plexus and urethra. Results: Correction of the recurvatum was achieved in all cases. In patients undergoing albuginea plication, the shortening of the corpus cavernosum ranged from 0.5 cm (1 case) to 2 cm. Patients with ED, particularly those who received a synthetic graft, continued to take iPDE5, with good erections. The graft has never induced inflammation, scar retractions or pseudo-aneurysm expansion, even in the medium term (5 years). Patient satisfaction was evaluated asking the patient to score it in scale from 1 to 4. The scale was administered 6-8 months after surgery. Patients treated with albuginea plication scored their satisfaction as it follows: 26 patients degree 3 (satisfied enough); 9 patients degree 4 (very satisfied); 4 patients degree 2 (satisfied); 1patient unsatisfied. In patients treated with patch: 2 patients degree 3 and 4 patients degree 4 (Table 1). Conclusions: A thorough diagnostic study of patients with proper indications for surgical treatment coupled with a careful and detailed evaluation of the patient’s expectations, followed by an extensive surgical dissection of the corpora cavernosa, provide good results for both tunica plication and the polyester fluoropolymer graft with a good degree of satisfaction of the patients. In our experience, this graft seems free of the complications thus far attributed to synthetic grafts.
Authors and Affiliations
Passavanti Giandomenico, Aloisi Anna Maria
Keywords
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- EP ID EP343365
- DOI 10.17352/2455-5495.000005
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