SURGICAL CORRECTION OF PEYRONIE’S DISEASE VIA TUNICA ALBUGINEA PLICATION- LONG TERM FOLLOW UP
Peyronie’s disease (PD) is an acquired connective tissue disorder of the tunica albuginea with fibrosis and inflammation that lead to palpable plaques, penile curvature and pain during erection, compromising quality of life. Patients report negative effects in four major domains: physically appearance and self-image, sexual function and performance, pain and social stigmatization. Aim of present study is to evaluate outcome in term of patient satisfaction, anatomical and functional correction at long term follow up after surgical plication of albuginea.
Materials and Methods
Between 1998 and 2006 a total of 204 patients with PD underwent surgical correction using albuginea plication technique. We obtained complete long term (at 5 and 10 years) follow up data in 187 cases.
After an average of 141 months the most common postoperative complications are loss of length (150 patients had a minimal penile shortening ≤ 1,5 cm, 37 between 1,5 and 3 cm, none >3 cm), recurrent or residual penile curvature (in 15 without impairing sexual intercourse) erectile dysfunction (15 patients had IIEF-5 < 10 at 5 years follow up vs 28 patients at 10 years), change in penile sensation (37 lamented paresthesia of the glans 1 year after surgery, 28 at 5 years and 15 at 10 years); painful or palpable suture knots (in 20 cases) spontaneously revolved in 3 months. Overall 77% of the patients and partners were completely satisfied with the outcome of surgery, 14% partially satisfied and 9% unsatisfied.
Regardless of surgical approach, all patients should be informed about the risk of penis shortening, hypoesthesia and residual curvature prior to surgery, being imperative open and honest discussion to avoid false expectations. The most common postoperative complications of this approach are loss of length, recurrent or residual penile curvature, ED, change in penile sensation, and painful or palpable suture knots. Many of these outcomes can be quite distressing for the patient and they may impact the operative technique selection and overall satisfaction postoperatively. In our hands this approach obtained good success for the correction of curvature, maintenance of erectile function and patient-reported treatment satisfaction.
The optimal surgical treatment for PD patients with erectile capacity is still controversial [1, 2]: lengthening procedures – mainly performed on the patients with severe penile curvatures and /or narrowing or hourglass deformities – and tunical shortening procedures including incisional/ excisional corporoplasty and non-incisional plication techniques. Penile prosthesis implantation is typically reserved for patients with PD and concurrent ED, especially non responders to medical management.
The advantage of our technique is that it avoids incision or excision the tunica and yet achieved the desired result of straightening the deformity by shortening the longer side. It is simple to perform and there is no risk of excising too much of tunica. If after tying a suture the deformity appears over or under corrected, the suture can be cut or applied again as the case may be.
The use of non-absorbable stitches reduced the risk of recurrence of the curvature by comparing the results to the data of those who useful absorbable stitches (Ebbehoj, Schroder-Essed[3,4]). The absorbable stitches probably cannot withstand the traction during replaced erections in the early postoperatively period. On the other hand, when nonabsorbable material is used, commonly problems are the formation of granuloma around the sutures and the unpleasant feeling of bumps under the skin. Very rarely the discomfort of the suture interfered with sexual intercourse with rates reported by Baskin and Hsieh as 0-10% [5, 6].
Plication procedure is safe and simpler to preform than the classical Nesbit’s procedure with shorter surgical time, lower costs and could be successfully performed also by less experienced surgeons. It has a minimal risk of de novo erectile dysfunction, a minimal risk of injury to the dorsal neurovascular bundle and may be used for a variety of angulation deformities, including multi-planar curvature and severe degrees of curvature obtaining good results in term of patient satisfaction for anatomical and functional correction.
1. Iacono F, Prezioso D, Ruffo A, Illiano E, Romeo G, Amato G
“Tunical plication in the management of penile curvature due La Peyronie’s disease. Our experience on 47 cases”. BMC Surgery 2012, 12 (Suppl 1):S25
2. Langston J.P. Carson C.C.” Peyronie's disease:plication or grafting” Urol Clin North Am (2011) 38:207-2016
3. Fried rich MG., Evans D., Noldus J.” The correction of penile curvature with the Essed-Schroder technique: a long term follow up assessing functional aspects and quality of life”.
BJU Int. (2000) 86: 1034-1038
4. Baskin LS., Erol A., Li YW. “Anatomy of the neurovascular bundle: is safe mobilization possible?” J Urol 2000: 164:977-980
5. Hsieh Jt, Liu SP., Chen Y.” Correction of congenital penile curvature using modified tunic all plication with absorbable sutures the long-term outcome and patient satisfaction”
Eur Urol,2007;52: 261-6
6. Makovey I, Higuchi TT, Montague DK, Angermeier KW, Wood HM. “Congenital penile curvature”. Curr Urol Rep (2012) 13: 290-297Argomenti: andrologia