LONG-TERM CLINICAL COURSE OF PEYRONIE'S DISEASE TREATED CONSERVATIVELY
Ryuichi KatoYoshikazu SatoHideki AdachiHiroki HoritaNoriyoshi SuzukiShin‐ichi HisasueTaiji Tsukamoto
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Abstract:
(Background) To evaluate the natural history of Peyronie's disease and to determine the suitable time for surgical treatment, we investigated changes of clinical findings of the disease over time.(Patients and Methods) We evaluated changes of plaque size, penile curvature and erectile dysfunction in 10 patients with Peyronie's disease. The mean follow-up period was 36.8 months.(Results) At the first examination, the mean plaque size of patients with erectile dysfunction was larger than that of those without erectile dysfunction, suggesting a positive association between size and erectile function. There was no significant relationship between plaque size and penile pain or penile curvature. The mean size of plaques decreased significantly compared with that at the first examination (p<0.05). However, penile curvature, pain and erectile dysfunction perisisted during the follow-up peirod in all but one patient, who showed improvement of penile curvature.(Conclusion) These results suggest that we may recommend a shorter observation period until surgery than we have done for some patients who want to be surgically treated.Keywords:
Penile curvature
Peyronie's disease, characterized by the formation of a fibrous plaque within the tunica albuginea of the corpora cavernosa, has long caused sexual dysfunction. Plication surgery has allowed a simple technique to correct the penile curvature caused by Peyronie' s disease. The 16-dot plication technique corrects the penile curvature with a high level of patient satisfaction and yet can be performed under local anesthesia. Slight adjustments can be made during the procedure, which allows greater precision toward penile strengthening. The 16-dot penile plication procedure has an 85% long-term success rate for achieving a straight erection by patient reporting. Minimal complications are reported, with penile shortening (0.5–1.5 cm) reported at 41%. With a mean operative time of 45 min and the ability to perform the procedure under local anesthesia, the 16-dot plication procedure is an important tool for the urologist for treatment of Peyronie's disease.
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Surgical correction of Peyronie’s disease remains the gold standard of treatment. The goals of surgery should be cosmetic improvement and the preservation or restoration of sexual function. Preoperative workup should include objective assessment of both curvature and erectile function, and shared decision-making with the patient to clearly understand expectations for surgery is critical, as there is a risk of penile shortening and erectile dysfunction with any Peyronie’s surgery. Peyronie’s surgeries fall into three broad categories: plication procedures, plaque incision and grafting, and placement of a penile prosthesis. While direct comparative studies are rare, plication surgeries are the most commonly performed, as they are technically simpler and have excellent satisfaction rates. Grafting techniques are most indicated for more severe cases. Prosthetic placement is appropriate for patients with concurrent erectile dysfunction, and placement alone can correct cases of mild curvature. Additional techniques to straighten the penis can be employed if needed.
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Background: Peyronie’s disease and erectile dysfunction is common related pathological condition and single treatment for both conditions is the goal. Objective: To report our practice in the managing of patients with Peyronie’s disease associated with erectile dysfunction. Patients and Methods: This study was carried out during the period of 2014-2018, twenty-one adult patients (39-68) years were treated by malleable penile implant surgery. All patients presented with Peyronie’s disease associated with erectile dysfunction. The sorts of additional maneuvers and their achievement in additional straightening the residual curvature have been stated. Results: We deliberate medical conditions that have an association between erectile dysfunction and Peyronie’s disease and performing straightening procedures, modeling was successful in decrease penile curvature and Patient satisfaction rates 80% for both patients, partners have been reported in this literature. Conclusion: However, when Peyronie’s disease exists with ED, the gold standard treatment is penile prosthesis surgery with additional straightening procedures. Keywords: Penile prostheses, Erectile dysfunction, Peyronie’s disease
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Peyronie's disease (PD) usually affects middle-aged men. This condition is characterized by fibrosis and plaque in the tunica albuginea that results in deformity of the penis and makes sexual intercourse difficult. We report a case of a 52-year-old male who presented with complaints of curvature of the erect penis and erectile dysfunction. Based on our imaging findings, the patient was diagnosed with PD. ultrasonography (USG), elastography, and CT findings are described.
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To evaluate the efficacy and safety of a new penile traction device (PTD), 'Penimaster PRO', in a group of patients with stable Peyronie's disease (PD) compared with a non-intervention group in a multicentre study.A total of 93 patients with chronic stable PD (without erectile dysfunction, with no significant pain, and with a unidirectional curvature of at least 45° being stable for > 3 months) were recruited and followed for a 12-week period. Of these patients, 47 were randomly assigned to the Penimaster PRO group (PG) and 46 to the non-intervention group (NIG). Patients were asked to apply the PTD 3-8 h a day for 12 consecutive weeks, with specific instructions regarding the progressive increase of traction force applied to the penis over time. The primary outcome of the study was the change in the degree of curvature measured in the fully erect state after intracavernosal injection of alprostadil at baseline, 1, 2 and 3 months. Other variables, such as the type of curvature, stretched penile length (SPL), Peyronie's Disease Questionnaire (PDQ) scores, erectile function domain of the International Index of Erectile function (IIEF-EF) score and adverse events (AEs) were also assessed in each visit.Forty-one patients in the PG and 39 in the NIG completed the study. There was an overall reduction in curvature of 31.2° (P < 0.001) at 12 weeks compared to baseline in the PG, representing a 41.1% improvement from baseline, which significantly correlated with the number of daily hours the device was applied in a dose-dependent manner. Those patients using the device < 4 h/day experienced a reduction of 15°-25° (mean 19.7°, 28.8% improvement; P < 0.05), while patients using the device > 6 h/day experienced greater curvature reduction, ranging from 20° to 50° (mean of 38.4°, 51.4% improvement; P < 0.001). In contrast, no significant changes in curvature were observed in the NIG. Furthermore, SPL increased significantly in the PG compared to baseline and compared with the NIG, ranging from 0.5 to 3.0 cm (mean 1.8 cm; P < 0.05). The IIEF-EF score also improved in patients in the PG (by a mean of 5 points). Mild AEs occurred in 43% of patients, such as local discomfort and glans numbness.The use of the Penimaster PRO PTD, a non-invasive treatment, should be offered to patients with stable PD for 3 consecutive months before performing any corrective surgery, as this provided a significant reduction in the curvature, an increase in penile length and a significant improvement of the symptoms and bother induced by PD.
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To assess novel surgical techniques in management of Peyronie's disease.Forty-three men underwent corrective surgery using either partial plaque incision and nongraft (PPING) or multiple plaque incisions and graft (MPIG). The technique used was determined intra-operatively. Patients were assessed at baseline and follow-up based on Peyronie's disease questionnaire patient-reported outcome measure (PDQ-PROM) and erectile function.The two groups were well matched in age and erectile function. At baseline MPIG group had greater deformity and poorer patient-reported outcome. Penile curvature improved from 67.9° to 10.5° in the PPING group and 77.9° to 7.1° with MPIG. PDQ-PROM improved from 29 to 13 in those who underwent PPING and 38.5 to 17.6 in those undergoing MPIG. Erectile function was preserved in both groups.These novel surgeries are effective in restoring penile shape and length while preserving erectile function. This is reflected in improved patient-reported outcomes. These findings should be verified by multi-institutional study.
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