Surgical correction of Peyronie's disease via tunica albuginea plication: long‐term follow‐up

Abstract

Peyronie's disease (PD) is an acquired connective tissue disorder of the tunica albuginea with fibrosis and inflammation that lead to palpable plaques formation, penile curvature, and pain during erection. Patients report negative effects on main domains such as physical appearance and self-image, sexual function, and performance. The aim of this study was to evaluate plication of the albuginea outcomes after a long-term follow-up period. Between 1998 and 2006, a total of 204 patients with PD underwent surgical correction with albuginea plication technique. We obtained complete long-term follow-up data in 187 cases. The follow-up data included evaluation of curvature correction, penile shortening, sexual function, complications, and patient satisfaction. After a mean follow-up of 141 months, the most common postoperative complications were: loss of length (150 patients had a minimal penile shortening ≤1.5 cm, 37 patient between 1.5, and 3 cm, none >3 cm), recurrent or residual penile curvature (15 patients, without impairing sexual intercourse), erectile dysfunction (15 patients had IIEF-5 < 10 at 5 years of follow-up vs. 28 patients at 10 years), change in penile sensation (37 patients experienced paresthesia of the glans 1 year after surgery, 28 at 5 years, and 15 at 10 years); painful or palpable suture knots (in 20 cases) spontaneously healed in 3 months. Overall, 77% of the patients and partners were completely satisfied, 14% partially satisfied, and 9% unsatisfied. Plication procedure is safe and simple to be performed compared with the classical Nesbit's procedure. It has a shorter surgical time, lower costs, and could be successfully performed by less experienced surgeons too. It has a minimal risk of de novo erectile dysfunction, injury to the dorsal neurovascular bundle. Results are good in terms of patient satisfaction according to anatomical outcome and functional correction.

The Natural History of Peyronie's Disease

“…Location of the plaque considerably differs across previous studies, being dorsal location the most frequent at disease onset ( Table 1 ) [ 18 19 20 21 ]. Similarly, deviation of erect penis is significantly changeable according to previous reports ( Table 2 ) [ 18 20 21 22 23 ]. Clearly, there might be some patients who traumatize their penis and, thus, develop a secondary curvature due to the inflammation process and loss of compliance.…”

Effects of patients’ understanding and choice of surgical types on postoperative outcomes of Peyronie's disease

“…Previous studies have demonstrated that penile shortening occurs in 41%–100% and 0%–40% of patients following various plication procedures and incision or partial plaque excision with grafting techniques, respectively. 18 25 26 27 Although penile shortening rarely results in intercourse difficulty, 28 patients often perceive that the loss of length is greater than the actual loss. 29 In our study, objective measurement of stretched penile length showed that the proportion of patients with shortening penile length and the degree of penile length loss were similar between patients who followed the doctor's recommendation and those who did not follow regardless of the type of surgery.…”

Recommandations pour l’évaluation et la prise en charge de la maladie de Lapeyronie : rapport du comité d’andrologie et de médecine sexuelle de l’AFU

“…[132][133][134][135][136][137][138][139] La satisfaction post opératoire varie de 43 à 98,5% [128,133]. Néanmoins l'absence de standardisation de cette mesure rend l'interprétation difficile, Paez et al considèrent l'insatisfaction comme fréquente chez les patients opérés d'une maladie de Lapeyronie Après tout type de plicature 47,7 % à 94 % des patients ont des rapports sexuels satisfaisants [129,130,[133][134][135][136][137][138][139] et 66 % des partenaires sont satisfaits par l'intervention [129]. La récidive de la déformation varie de (2,1 % et 22,2 %) [132,[135][136][137][138].…”

“…[131] Dans les 2 premières années suivant la plicature, l'apparition d'une DE ou l'aggravation d'une DE préexistante est faible le plus souvent [139][140][141][142][143][144][145], mais peut varier et s'aggraver avec le temps notamment avec l'apparition de facteurs de vieillissement physiologiques et l'apparition de facteurs de comorbidité, rendant l'interprétation des résultats difficiles. [123][124][125][126][127][128][129][130][131][132][133][134][135][136] Les noeuds sont fréquemment palpables après plicature (33,3 % à 81 %), mais peu souvent responsables d'une gêne (1,7 % à 6 %). Pour cette raison, les points peuvent être inversant et utiliser différents types de sutures résorbables et non résorbables.…”

“…Pour cette raison, les points peuvent être inversant et utiliser différents types de sutures résorbables et non résorbables. [137][138][139][140][141] D'autres complications plus rares ont été rapportées avec des douleurs résiduelles : des troubles de sensibilité du gland [134], les plaies de l'urètre [130,136], les rétentions aiguës d'urine, les hématomes péniens, les infections du site opératoire. Le risque de phimosis secondaire est faible et la posthectomie est à proposer au cas par cas avec le patient.…”