A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the ‘sliding’ technique for end‐stage Peyronie's disease with severe shortening of the penis and erectile dysfunction

Abstract

Objectives To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the ‘sliding’ technique (ST). Patients and Methods From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end‐stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Questions 2 and 3, and the Peyronie's disease questionnaire (PDQ) were completed preoperatively by all patients. At the follow‐up visits (at 3, 6 and 12 months), the IIEF, the SEP Questions 2 and 3, the PDQ, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were completed. The outcome analysis was focused on penile length restoration, and intra‐ and postoperative complications classified according the Clavien–Dindo Classification. Results The mean (range) follow‐up was 37 (9–60) months. A malleable penile prosthesis (PP) was implanted in seven patients, while an inflatable three‐pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen‐fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II) and PP infection requiring the removal of the device (7%) (Grade III). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5–4) cm and no patient reported recurrence of the curvature. Conclusions The present series suggests that, in the hands of experienced high‐volume surgeons, penile length restoration with the use of the ST represents an effective option for end‐stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow‐up will be required to fully establish the efficacy of this procedure.

Peyronie’s disease: Contemporary evaluation and management

“…Over the past decade, several techniques have been developed and refined to optimize penile length in the setting of PD and prosthesis placement. Examples include circumferential tunical grafting and the sliding technique, wherein hemicircular incisions are made along the dorsal (proximal) and ventral (distal) corpora after elevation of the neurovascular bundle and urethra 152,153 . These incisions are then connected by bilateral longitudinal incisions with subsequent grafting, which might involve a substantial amount of suturing if traditional graft materials are used.…”

Surgical Management of Peyronie’s Disease With Co-Existent Erectile Dysfunction

“…A multicentric study by Rolle et al 44 reported a 95% patient satisfaction rate in a total of 28 patients who underwent the sliding technique and grafting with concomitant PP. The grafts used were porcine small intestinal submucosa (SIS) Surgisis (Cook Medical, Bloomington, IN, USA), acellular porcine dermal matrix Pelvicol (CR Bard, Covington, GA, USA), or collagen fleece TachoSil (Baxter Healthcare, Deerfield, IL, USA); the majority being SIS in 19 patients (67.8%).…”

117 Non-degloving Technique for Peyronie's Disease with Penile Prosthesis Implantation and Double Dorsal-ventral Patch Graft

“…17,18 Recent studies have demonstrated that the ST is an effective method to not only perform PP implantation but also restore length in patients with severe PD and ED. 6,7,16,19 Rolle et al 7 conducted a multicentric study on the outcomes of the ST with complete degloving of the penile shaft in 28 patients. The ST demonstrated an intraoperative straightening of all penises, an average increase of 3.2 cm in penile length, and an overall increase in patient satisfaction rate at the expense of a slight increase in complications.…”

“…6,7 This approach is generally preferred as it allows adequate exposure of the surgical site and allots space for deep corrective sutures. However, as the glans is the most distal aspect of the penis, it is susceptible to ischemic and lymphatic complications during degloving.…”