A Retrospective Comparative Study of Traction Therapy vs. No Traction Following Tunica Albuginea Plication or Partial Excision and Grafting for Peyronie’s Disease: Measured Lengths and Patient Perceptions

Abstract

Introduction Loss of penile length is a recognized and common consequence of Peyronie’s disease (PD). Traction therapy (TT+) has been reported to decrease post-op length loss as well as increase stretched penile length (SPL) prior to surgery. Aim The aim of this study was to study patient outcomes with penile length change and patient satisfaction after surgery following tunica albuginea plication (TAP) and partial plaque excision and grafting (PEG) with or without postoperative TT. Methods Retrospective analysis was performed from our cohort of Peyronie’s reconstructive surgery between 2007 and 2010. SPL was measured dorsally from pubis to corona and recorded at the initial office visit and then compared to most recent postoperative visit. Patients were then stratified by procedure and whether TT was used (TT+ and TT−; TAP N = 52 [27 TT+ and 25 TT−] and PEG N = 59 [36 TT+ and 23 TT−). Traction therapy was initiated for >2 hours a day for 3 months typically starting 3–4 weeks postoperatively. A non-validated mailed questionnaire assessed patient perceptions. Results Mean length change seen in TAP (TT+) was 0.85 cm (0.25–1.75) vs. −0.53 cm (−1.75 to 0.5) in TAP (TT−) (P < 0.001). The mean length change seen in PEG (TT+) was 1.48 cm (0–6) vs. PEG (TT−) 0.24 cm (−1 to 2.5 cm) (P < 0.001). Sixty-one percent of surveys were returned; 85% lost length prior to the initial office evaluation, with an average of −2.5 cm lost. Importantly, in those who used traction, there was no perceived length loss, 58% reported a mean erect length gain of 1.1 cm. However, only 54% of all patients were satisfied with their current erect length. Conclusions Loss of length in men with PD remains a serious concern. It appears that postoperative TT can result in length preservation, and in many, a measured and perceived length gain following correction of the curvature.

Extracorporeal Shock Wave Therapy in Peyronie's Disease: Results of a Placebo-Controlled, Prospective, Randomized, Single-Blind Study

“…Several nonsurgical treatment options have been investigated in the last decade, but no one therapy can relieve all symptoms associated with PD [1,3,[7][8][9][10][11][12][13]. Surgery is the gold-standard to correct deviation [3,8,[14][15][16][17][18].…”

Peyronie’s disease: Contemporary evaluation and management

“…Shortening is more common in men with ventral and ventrolateral penile curvature, and in those with more severe curvature (>60°) 99 . This might be mitigated by carrying out adjunctive maneuvers, such as preoperative and postoperative PTT 99,106,107 . To date, there is no strong evidence to support one incisional/excisional corporoplasty or plication technique over another with respect to optimizing postoperative outcomes.…”

2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

“…There are three broad categories of TA plaque incision (double-Y, H-shaped, and Egydio geometric) that are made at the point/relative to the maximum curvature on the convex side of the penis, followed by placement of a graft material(autologous, allografts, xenografts, and synthetic) to repair the defect and potentially lengthen the shorter side of the penis. 1,3,[69][70][71][72]76,78,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101] There is a strong trend towards minimal TA disruption, therefore favoring incision or partial excision techniques;…”

“…78 A retrospective study determined perception of length loss is minimal when traction therapy was utilized although dissatisfaction with penile length post-operatively remained high at almost half of surveyed patients. 87 There is no universally accepted optimal graft material; the search remains for an inexpensive, readily available graft that mimics the TAs strength and elastic characteristics, has minimal morbidity (including harvest) and tissue reaction, is pliable and easy to suture, resists infection, and preserves erectile capacity. 76,78 Tissue-engineered grafts may represent the future but in the meantime, currently available grafts are associated with potential complications commonly linked to significant patient dissatisfaction, the most important of which is ED and can occur in upwards of 25% of patients.…”