ANALYZING SATISFACTION RATE IN PATIENTS WITH PEYRONIE’S DISEASE UNDERWENT ALBUGINEAL GRAFTING AND PENILE IMPLANT
Peyronie’s disease (PD) is a benign, localized connective tissue disorder characterized by the abnormal deposition of collagen with the formation of fibrous, inelastic plaques in the tunica albuginea of the corpora cavernosa, which causes penile deformity during erection and Erectile Dysfunction (ED).This disorder is frequently associated with anatomical alterations of the shaft and penile shortening and has a major impact on quality of life and significant psychological effects .The aim of this study is to analyze the satisfaction rate in patients underwent albugineal grafting and penile implant.
Materials and Methods
From March 2015 to April 2016 13 patients with PD were recruited. with stable disease at list for six months. 9 patients reported ED assessed by questionnaire IIEF – 5 (14 + – 2), degree of curvature> 50 ° in 9 patients, complex deformities in 3 patients and in one patient there was a penile shortening due cavernosal fibrosis.
The surgical procedure started with a sub coronal approach. The penis was degloved. Buck's fascia was dissected from the albuginea.With an artificial erection we identified the maximum curvature point, thanks to dermographic pen in order to asses the angle of curvature. A double Y incision is performed on the tunica albuginea.
The defect was musered and covered with a patch of porcine derma and sutured to the albuginea with a continuous suture in 4-0 polydioxanone.
Penile prosthesis (AMS 700 CX) was inserted using using a peno-scrotal incision and inflated at 80% of the maximum capacity for the next two weeks. The patients were discharged 2-3 days after surgery.
All patients were proposed therapy Vacuum device for the next 6 months.
The assessment of patient satisfaction was measured with modified EDITS questionnaire at 6 months after surgery.
This consists of 5 macro areas (overall satisfaction, self-confidence, loss of post-operative sensitivity, length of postoperative penile length loss of the post -operatoria penis); the patient could validate only one choice among the three proposals (satisfied, not very satisfied and not satisfied).
The results at 6 months after surgery were:
84% (11 patients) of the patients was satisfied with the result of surgery.
2 patient (7.7%) was half satisfied with the result.
10 patients (76.9%) of patients had received greater security in the relationship with their partners after the surgery.
The third macro areas regard the loss of post-operative sensitivity of the 13 analyzed patients, 9 (69.2%) reported no loss of post – operative sensitivity, and only 4 (38.4%) reported minimal loss of sensitivity.
92.3% of patients, when asked about the length of the penis were satisfied, and only 1 patient (7.7%) not at all satisfied.
Finally, in no patient it was found loss of penile length.
Surgery is the only effective tool in the management of severe PD. Unfortunately albugineal grafting results in a high rate of postoperative ED. Albugineal grafting and penile prosthesis implantation is the only technique able to restore penile size and guarantee pts' satisfaction.
The psychological implications of Peyronie's disease is a factor to be considered when setting the therapy with surgery.
In this study, we have shown that the 'surgery and penile prosthesis implantation, associated with post-operative rehabilitation with vacuum device, leads to a high satisfaction rate and greater self-confidence.
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