Abstract 1003

 Men who had ED which did not respond to PDE5 inhibitors, intracorporeal injection or vacuum device were excluded. Preoperative evaluation includes dynamic color duplex ultrasonography. Patient ultimately chose the surgical approach that they would prefer after consultation with the surgeon. Plication was performed under local anesthesia while grafting required general or regional anesthesia. Telephone interview at one year of follow-up was conducted to obtain subjective reports on outcomes. Surgical success was defined as correction of curvature with patient satisfaction of at least 75%.

For the plication group, 85% were very satisfied and had no change in erection quality. One had persistent pain and two complained of significant shortening which interfered with coitus. In the grafting group, 70% were very satisfied. Of the six unsatisfied men, two were due to the persistent curvature and four due to poor erection with decrease in penile sensation. 33% complained of shortening with significant bother in three men. The authors concluded that plication was a simpler operation with minimal complications, which were comparable to incision with venous grafting.

Editor's note: There is an art to surgery; the operative management of Peyronie's Disease reflects this. What is the deformity, what is the erectile status, how best to correct the deformity and not further shorten the penis, how best to preserve the erections - these are the questions each thoughtful surgeon asks. I question whether patients are actually 'choosing the surgical approach' in this series. Clearly the presentation of risks and anticipated outcome given by surgeon is the main determinant of what patients 'choose' when facing options for reconstructive surgery. Plication is technically easier, faster and less risky than plaque incision, excision and grafting but 'one size does not fit all'. It takes a good deal of experience with a variety of techniques to make the best recommendation to your patient, and even with that most experienced surgeons will tell you that satisfaction with outcomes from these operations is modest, with the patient's recall of what his penis looked liked before Peyronie's disease assuming mythical proportions.

DH Kim, MH Ree, JR Kaswick, AS Pathak, JP Brusky, and SR Aboseif

Link: Abstract 1003

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