Correction of penile curvature and Peyronie’s disease: why I prefer the Nesbit technique

Pryor, J. P.

doi:10.1038/sj.ijir.3900331

Cited by 41 publications

(16 citation statements)

References 9 publications

(11 reference statements)

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“…Despite this, penile prosthesis insertion is associated with a low, but well-defined, incidence of complications and represents a secondary management strategy for some patients [5][6][7]. In carefully selected patients, other surgical strategies such as modified corporoplasty (MC) and plaque incision and grafting (PIG) result in penile deformity correction with excellent patient satisfaction without the need for a penile prosthesis [8,9].…”

Section: Introductionmentioning

confidence: 99%

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A Surgical Algorithm for Men with Combined Peyronie's Disease and Erectile Dysfunction: Functional and Satisfaction Outcomes

Mulhall

Anderson

Parker

2005

The Journal of Sexual Medicine

109

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Introduction Men with Peyronie's disease who also have erectile dysfunction represent a challenge to the urologist. Historically, penile prosthesis surgery has been the management strategy of choice for this population. This study was undertaken to define the outcomes of a penile reconstructive surgery algorithm in men with Peyronie's disease and concomitant erectile dysfunction (ED). Methods Patients presenting with combined Peyronie's disease and erectile dysfunction were treated with vasoactive therapy initially. All patients underwent dynamic infusion cavernosometry and cavernosography. Nonresponders to erectogenic pharmacotherapy were advised to undergo penile prosthetic surgery. Responders to erectogenic therapy were considered candidates for either corporoplasty or plaque incision and grafting. The International Index of Erectile Function (IIEF) questionnaire was used to compare erectile function and satisfaction profiles serially pre- and postoperatively between the patients in the three groups. Results Sixty-two patients constituted the study population. Eighty-one percent of the patients responded to erectogenic pharmacotherapy. Postoperative IIEF erectile function domain scores were statistically higher for implant patients and lower for plaque incision and grafting patients compared to preoperative scores. Postoperative IIEF satisfaction domain scores were higher for corporoplasty and implant patients and lower for plaque incision and grafting patients compared to preoperative scores. Conclusions The surgical algorithm used in this study leads to excellent IIEF erectile function and satisfaction scores for corporoplasty and implant patients; however, plaque incision and grafting patients had poor functional and satisfaction outcomes. These data support the concept that not all men with combined ED and Peyronie's disease require penile prosthetic surgery, and furthermore, plaque incision and grafting surgery is a poor option for men with combined disease.

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Section: Introductionmentioning

confidence: 99%

“…Modified corporoplasty surgery is believed not to be associated with hemodynamic alterations [9,10], while PIG surgery has been associated with erectile function changes in up to 24% of men [2,8,11,12].…”

Section: Introductionmentioning

confidence: 99%

A Surgical Algorithm for Men with Combined Peyronie's Disease and Erectile Dysfunction: Functional and Satisfaction Outcomes

Mulhall

Anderson

Parker

2005

The Journal of Sexual Medicine

109

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“…Plaque size is measured in the flaccid penis. Clinical estimation of the deformity compared well with the operative findings [6]. Assessment of the quality of erection should be made.…”

Section: Assessmentmentioning

confidence: 99%

Peyronie's Disease

Pryor

Akkuş

Alter

et al. 2004

The Journal of Sexual Medicine

122

101

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Introduction Peyronie's disease is a sexual medicine condition that may adversely affect male sexual function. Aim To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of Peyronie's disease. Methods An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Peyronnie's disease committee, there were 10 experts from six countries. Main Outcome Measure Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation. Results Peyronie's disease is characterized by an inflammatory response beneath the tunica albuginea with fibroblast proliferation forming a thickened fibrous plaque that may cause penile pain, penile curvature and erectile dysfunction. Medical treatments have been described but few prospective controlled trials have revealed significant clinical benefits. Surgical treatments (penile plication, Nesbit excision, plaque incision and grafting and penile prosthesis insertion) should be considered after Peyronie's disease has stabilized. Surgical outcome studies reveal that a stable deformity is best corrected with the least postoperative ED by a Nesbit procedure. Plaque incision and grafting should be reserved for men with good erectile function and marked penile shortening although there is a higher prevalence of postoperative ED. Implantation of a penile prosthesis is an excellent option for men with an accompanying erectile deficit. Conclusions Safe and effective treatments for Peyronie's disease examined by prospective, placebo-controlled, multi-institutional clinical trials are needed.

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“…Das am häufigsten eingesetzte Verfahren ist hierbei die Operation nach Nesbit, bei der auf der gesunden Gegenseite eine oder mehrere Keilexzisionen aus der Tunica albuginea vorgenommen werden und so eine Begradigung erzielt wird [58,67,65]. Nachteil dieser Methode ist eine relative Penisverkürzung.…”

Section: Operative Behandlungsverfahrenunclassified