Outcomes of Surgical Management of Men with Peyronie's Disease with Hourglass Deformity

OBJECCTIVE - To investigate the outcomes of two surgical interventions for Peyronie's disease (PD) with hourglass deformity: partial excision and grafting (PEG) or inflatable penile prosthesis (IPP) implantation.

MATERIALS AND METHODS - Retrospective data was collected from two centers: Technical University of Munich (PEG) and Tulane University Medical Center (IPP). Collected variables included patient demographics, sexual function, penile vascular measurements, and treatment outcomes.

RESULTS - A total of 50 PD patients with hourglass deformity (26 PEG [group 1] and 24 IPP [group 2]) were included in this study. Patients in group 1 had higher mean pre-operative Sexual Health Inventory for Men (SHIM) scores (22. 2 vs. 10. 3, p<0. 0001), required less ED treatment (35% vs. 79%, p=0. 005), and had more non-vascular etiology (77% vs. 21%, p<0. 0001). There were no intra-operative complications, two patients in group 1 had post-operative glans hypoesthesia, and one patient in group 2 required surgical revision. All patients in both groups had significant ≥20% improvements in penile curvature with mean changes of 68. 1 degrees (12. 7) in group 1 and 49. 6 degrees (13. 5) in group 2, p<0. 0001. Resolution of hourglass deformity was achieved in 85% of patients in group 1 and 100% of group 2, p=0. 045. The mean post-operative change in SHIM score was -0. 3 (1. 3) in group 1 and 16. 7 (4. 7) in group 2, p<0. 0001.

CONCLUSIONS - Both options provide excellent outcomes for well-selected patients with PD and an hourglass deformity. PEG can be offered to patients with good erectile function, while the IPP remains the preferred option for patients with poor erections.

Urology. 2016 Feb 11 [Epub ahead of print]

Faysal A Yafi, Georgios Hatzichristodoulou, Julie Wang, James Anaissie, Suresh C Sikka, Wayne J G Hellstrom

Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. , Department of Urology, Technical University of Munich, Munich, Germany. , Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. , Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. , Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. , Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. 

PubMed

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