Penile length and girth restoration in severe Peyronie's disease using circular and longitudinal grafting - Abstract

The association between Peyronie's disease (PD) and erectile dysfunction (ED) is reported to be 20-70%.

Frequently, men who suffer from both ED and PD do not respond to erectogenic medication. In such cases, a simple straightening operation does not provide any benefit to the patient, as inadequate rigidity still impedes sexual intercourse. For these patients, surgical correction of the curvature should be performed with simultaneous penile prosthesis implantation. Penile prosthesis implantation guarantees a functional straight penis. Almost all patients report adequate rigidity for sexual intercourse postoperatively; however, in up to 50% of cases, patients are dissatisfied with the postoperative penile length. In cases of penile prosthesis implantation for PD, a simultaneous penile lengthening procedure should be performed to increase postoperative satisfaction rates. We report our experience using a novel method for restoration of penile length and girth in patients with PD by grafting. Our study shows that penile prosthesis implantation with concomitant penile lengthening and girth restoration based on circumferential tunica albuginea incision is highly effective for extensive penile shaft reconstruction to correct severe penile shortening and narrowing, resulting in maximum penile length gain and girth restoration, regardless of plaque characteristics.

OBJECTIVE:To report patient outcomes and satisfaction with our technique for penile length and girth restoration in severe Peyronie's disease (PD).

PATIENTS AND METHODS:Between November 2006 and November 2011, 105 men with severe PD and erectile dysfunction (ED) underwent surgical correction using our new approach. The technique consists of penile prosthesis implantation with concomitant penile lengthening and girth restoration through circular and longitudinal incisions in the tunica albuginea according to geometric principles.

RESULTS:The overall patient satisfaction rate was 89.4%. The mean (sd; range) functional penile length gain was 3.6 (0.7; 2-5) cm. Patient satisfaction with penile length gain was 95.2%. Three patients (2.9%) developed retraction with residual curvature of up to 30°, but no re-operation was necessary.  In one (1%) patient, the prosthesis had to be removed because of wound infection. At a mean (sd; range) follow-up of 18.2 (5.9; 6-46) months, 104 patients (99%) were able to have sexual intercourse.

CONCLUSIONS: Our surgical approach for penile length and girth restoration leads to high patient satisfaction rates and excellent functional outcomes. Our surgical approach is a safe and valid therapeutic method for the treatment of severe PD associated with ED.

Written by:
Egydio PH, Kuehhas FE, Sansalone S.   Are you the author?
Centre for Peyronie's Disease Reconstruction, Sao Paulo, Brazil; Department of Urology, Medical University of Vienna, Vienna, Austria; School of Medicine Tor Vergata University of Rome, Department of Urology, Rome, Italy.

Reference: BJU Int. 2012 Oct 26. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11582.x

PubMed Abstract
PMID: 23107452 Peyronie's Section