Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature

Abstract

Background There are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening (<20 degrees). Aim This study highlights the clinical distinction and our experience with men with PD and severe compound curvature treated with PEG and supplemental tunica albuginea plication (TAP). Methods We performed a retrospective chart review of patients with PD and acute angulation who underwent PEG (group 1) and patients with compound curvature who underwent PEG with TAP (group 2) between 2007 and 2016. Outcomes Primary post-operative outcomes of interest include change in penile curvature, change in measured stretched penile length, and subjective report on penile sensation and sexually induced penile rigidity. Results 240 Men with PD were included in the study, of which 79 (33%) patients in group 1 underwent PEG and 161 (67%) in group 2 underwent PEG and TAP. There was no difference in associated PD co-morbidities including age, hypertension, hyperlipidemia, hypogonadism, diabetes, or tobacco use. After artificial induction of erection with intracorporal trimix injection, the average primary curvature was 73 (range, 20–120) degrees for group 1 compared to 79 (range, 35–140) degrees for group 2 (P = .01). Group 2 had an average secondary curvature of 36 (20–80 degrees). After completion of PEG, men in group 2 had an average residual curvature of 30 (range, 20–50) degrees which required 1–6 TAPs to achieve functional straightness (<20 degrees). At an average follow-up of 61 months, there was no difference for group 1 and group 2, respectively, for recurrent curvature (11.4% vs 12.4%, P = .33), change in penile length (+0.57 vs +0.36 cm, P = .27) or decreased penile sensation (6% vs 13%, P = .12). In all, 81% of group 1 and 79% of group 2 were able to engage in penetrative sex after penile straightening with or without pharmacotherapy (P = .73). Clinical Translation Our review shows promising surgical outcomes for the use of PEG and supplemental TAP for this subtype of complex PD. Strengths and Limitations This article reports the largest experience with treatment of PD with compound curvature to date. Limitations of this study include the retrospective nature of the analysis as well as the lack of a validated objective measurement of erectile function after penile straightening. Conclusion Our study found no baseline difference in underlying co-morbidities in men with severe compound curvature compared with men with acute severe angulated curvature. Men with severe compound curvature represent a severe and under-recognized population of men with PD who can be surgically corrected with PEG and supplemental TAP(s) when needed without an increased risk of loss of penile length, recurrent curvature, decreased penile sensation, or erectile dysfunction when compared to men treated with PEG alone.

Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie’s Disease

“…Again, penile recurvature and shortening, as well as vasculogenic ED, were all attributed to graft contracture/scarring. A very recent study from the same working team (Table 3) demonstrated, in line with our findings, that the addition of plication stitches to plaque excision and Tutoplast grafting in men with severe compound curvature provided similar results to plaque excision and grafting alone 19 …”

Penile curvature after Peyronie’s disease surgery: What are the risk factors?

“…The complimentary plication was needed for the bi‐planar nature of curvature in fifteen patients (34%). In similar studies, the combined approach rate and percentage of bi‐planar patients in this group were reported as 67% and 33% (Chow et al., 2018). Although the ratio of patients who needed additional plication was higher in the recurrence group (33.7% vs. 45%), it was not statistically significant.…”

Grafts in Peyronie’s surgery without the use of prostheses: a systematic review and meta-analysis

“… 18 19 20 21 Tutoplast resulted in added penile length ranging from 0.2 cm to 0.7 cm. 22 23 24 25 SIS had an overall mean added length of 0.6 cm, with self-reported penile shortening ranging from 5% to 65%. 26 27 28 29 BMG resulted in the highest overall added penile length of 1.6 cm to 2.4 cm and low level of penile shortening ranging from 0 to 15.4%.…”