Surgical Management for Peyronie's Disease

Abstract

Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations.

1124 The Egydio geometrical procedure for managing penile curvature using a single relaxing incision: A single-centre experience with 330 patients

“…Current graft technology provides a great range of graft materials to be used for the restoration of tunica albuginea defects [10,11]. However, we still do not know which is the ideal technique and graft material [12,13].…”

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

“…A single universal procedure that defines surgical standard of care or optimal approach does not exist; procedures for PD include penile plication, plaque incision/excision with grafting, and penile prosthesis implantation. 1,3,[66][67][68][69][70][71][72][73] Penile reconstructive procedures do not fall into the domain of all urologic surgeons and it is entirely appropriate to utilize subspecialty colleagues for PD surgical management in order to optimize patient outcomes, given the fact that expertise with all three surgical approaches portends greatest chance of satisfactory result.…”

Recent surgical advances in Peyronie’s Disease

“…16 These exams, along with biothesiometry are not evidence-based recommendations prior to surgery. 11 The restoration of penile and sexual functionality is the primary goal of surgical intervention for the patient to resume normal sexual activity. Reconstructing a perfect straight penis, recovery of substantial penile length or normalized penile sensation, and spontaneously normalized erectile function, may not always be possible.…”

“…An history of penile trauma must be sought (reported in 5% -13% of cases) 5 as well as Dupuytren's contracture (associated risk of 3% -22 % of PD), Ledderhose disease and tympanosclerosis. 5,11,12 Important determinations during consultation are regular measures of stretched penile length, girth measurement, penile sensation to touch and degree of penile curvature. 13 Patient self-reporting of penile curvature is unreliable and should not be used as a clinical objective marker and an objective evaluation through a proper clinical examination of the erect penis (induced pharmacologically) is needed.…”

“…Reconstructing a perfect straight penis, recovery of substantial penile length or normalized penile sensation, and spontaneously normalized erectile function, may not always be possible. 11 One must set realistic expectations and address potential complications like penile shortening, decreased rigidity, residual or recurrent deformity, decreased sensation and ED. 5 …”