Peyronie`s disease surgery: Surgical outcomes of 268 cases

Özet

Objective: To assess the outcomes of the surgical techniques used in Peyronie’s disease (PD) surgery.Material and methods: Two hundred and sixty-eight patients received surgical treatment for PD. Fifty fourand 144 patients underwent simple corporoplasties (shortening procedure, SP, group 1) or plaque incisionand grafting surgery (lengthening surgery, LP, group 2), respectively, whereas 70 patients with erectile dysfunctionunderwent penile prosthesis implantation.Results: Penile plication and Nesbit surgeries were performed in 5 (9%) and 42 (78%) patients out of total 54patients. In the remaining 7 (13%) patients, Nesbit and plication suture combination was required for completepenile straightening. Mean curvature degree was 52.2±12.3 degrees. Follow up time was 36.1±29.4 months. Nosignificant difference was demonstrated between the two groups in the baseline features and co-morbiditiesexcept age. In 144 patients who underwent plaque incision and grafting, mean age and PD onset duration were54.1±9.2 years and 28.2±17.3 months respectively. Mean curvature degree was 58.4±18.9 degrees. Post-operativefollow up time of the second group was 51.1±39.6 months. Additional plication suture was used in 48 patients(33%) patients. Degree of curvature improvement was 37.9±19.1 and 52.1±23.5 in SP and LP respectively(p=0.01). The initial anatomic success rates were 90.4% and 87.5% at their early post-operative follow-upsfor group 1 and 2 respectively. These rates dropped to 82.7% and 83.6% at the long term follow-up (36 and 51months) respectively (p=0.9). Although the average follow-up time of LP group was longer than SP group (52.1mo vs. 37.0 mo), recurrence rates of these two groups were comparable. The combined functional and anatomicalsuccess of patients were demonstrated to be 79% and 75% in shortening and grafting surgery. Shorteningsurgery was not statistically superior to grafting surgery for patients in terms of having erection with or withoutthe aid of PDE-5 inhibitors (94.4% vs. 88.2%, p=0.28). Shortening surgery makes a difference in the long termfollow-up for patients who had erections without the aid of PDE-5 inhibitors (90.7% vs. 67.3%, p=0.02).Conclusion: Both SP and LP are successful in terms of penile straightening in the short and long-term follow-up. Curvature degree improvement is greater in LP. Patients who undergo LP surgery may suffer fromED in the long-term follow-ups. Greater percentage of patients who underwent LP require PDE-5 inhibitorsusage for sexual intercourse. Despite stated shortcomings, combined success (anatomic and functional) isachieved in three out of four patients for both groups. Penile prosthesis implantation should be preferred forpatients with ED and penile deformity.