Long-term patient satisfaction after surgical correction of penile curvature via tunical plication

Abstract

Objective: To assess patient satisfaction and functional results at long term follow-up after surgical correction for Peyronie's disease (PD) and congenital penile curvature (CPC) with the technique of tunical plication. Materials and Methods: One hundred and two men operated for PD (n = 76) or CPC (n = 26) in four different departments of urology in public hospitals agreed to answer a six-question telephone questionnaire about treatment satisfaction. Tunica albuginea plication procedures represented the standard surgical approach. Subjects under investigation were correction of the deformity, feeling of bumps under the skin, pain during erection, penile sensory changes, development of erectile dysfunction (ED) and postoperative ability for complete vaginal intromission. Subjective response rates were compared using the chi square test on the basis of the etiology of the disease (CPC or PD). Results: Significant differences (p < 0.05) between patients with CPC and PD were noticed in the prevalence of postoperative penile deformity, sensory changes, ED and ability to complete vaginal intromission, PD patients always showing a more pessimistic view. No significant differences (p = ns) were detected in terms of unpleasant nodes under the penile skin or pain during erection. Conclusions: Long-term outcome after surgical correction for PD and CPC with the technique of tunical plication can be poor. Probably patient expectations are above the real performance of surgical techniques. Preoperative information should be more exhaustive.

Outcomes of surgical treatment of Peyronie's disease

“…Indications for tunical shortening include: adequate preoperative rigidity with or without pharmacotherapy, adequate penile length, simple curvature <60°, distal penile curvature with no hourglass deformity or hinge, or assumed loss of length <20% of total erect length . Tunical shortening procedures include the Nesbit, modified Nesbit and penile plication variations (Table ) . In brief, the Nesbit entails an elliptical excision of the tunica albuginea contralateral to the area of maximal curvature, thereby shortening the longer side of the tunica albuginea to match the length to the shorter side .…”

“…The Nesbit procedure was the original tunical shortening technique and was initially used for the correction of congenital penile curvature caused by corporal disproportion. Modifications of tunical shortening techniques include the Yachia , Giammusso , Lemberger and Essed‐Schröeder techniques, the 16‐ or 24‐dot procedure , the penoscrotal plication procedure and tunica albuginea plication (Table ).…”

Safety and tolerability of local treatment with iloprost, a prostacyclin analogue, in patients with Peyronie's disease: a phase I study

“…The completion of phase I requires a further study on a larger scale which should also contemplate the use of concentrations higher of 400 ng and/or more frequent sessions. Regarding the efficacy, the need to use measurable parameters (in addition to AHP) to clearly define the progress of therapy led us to use a subjective questionnaire that takes into account the whole spectrum of symptoms and their modifications [26–29]. Owing to the small sample size of the present study, and the fact that it was not randomized and had no placebo control group, evaluation of efficacy is limited, but the present data warrant future investigation to obtain a more significant improvement of the disease.…”

The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding

“…Potential complications associated with surgery include penile shortening, sensation change, recurrence of penile curvature, and subsequent erectile dysfunction (Chung et al, 2010;Kadioglu et al, 2006). Surgical complications or unexpected outcomes can have psychological consequences in addition to the psychological components of Peyronie's disease itself and may result in patient dissatisfaction with surgery (Akin-Olugbade et al, 2006;Chung et al, 2010;Fazili et al, 2007;Paez et al, 2007). Given the potential complications or recurrence of disease after surgery, patient expectations must be managed carefully (Akin-Olugbade et al, 2006;Hauck, 2006;Kim et al, 2008;Usta et al, 2003).…”