The objective was to assess sexual function at long-term follow-up after the Nesbit operation for Peyronie's disease.One hundred and ®fty seven out of 213 patients treated between 1986 and 1998 using the Nesbit procedure were reassessed by means of IIEF-5 questionnaire together with two questions about residual deformity and treatment satisfaction. The results from this questionnaire together with the patient case records constitute the basis of this paper.After an average 72-month follow-up subjective patient determination of satisfaction indicated that 87.9% were satis®ed with the results of surgery, 136 patients (86.7%) had good erectile function (IIEF-5 b 21). Shortening of the penis (from 1.5 to 3 cm) occurred in 22 patients (14%), but only in 2 (1.3%) was intercourse dif®cult because of excessive shortening.In conclusion, the Nesbit's operation results in the greatest amount of patient satisfaction about sexual function. When penile shortening occurs, it has not been a signi®cant problem for patients who are properly counselled.
Our objective was to investigate the prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC) in patients with severe Peyronie's disease. These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Twenty patients with severe Peyronie's disease underwent penile color Doppler US after intracavernous injection of prostaglandin E(1). Study inclusion criteria were penile curvature or shortening which made intercourse difficult or impossible. The quality of erectile response was subjectively scored. The spectral characteristics of CSC were evaluated in comparison with waveform changes in cavernosal artery. There were 4 patients with normal erectile response, 10 with discrepancy in rigidity of the penile base and tip, 4 with veno-occlusive dysfunction and 2 with arteriogenic dysfunction. The CSC just proximal to the plaques had peak systolic velocity (PSV) significantly higher and resistance index (RI) significantly lower than the other CSC. The PSV in CSC near the plaques of patients with base-tip discrepancy and with veno-occlusive dysfunction were significantly higher than in the other patients. In patients with severe Peyronie's disease CSC near the plaques remain patent with low-resistance flow supporting the hypothesis that blood leakage can occur through these vessels.
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