10 Years’ Plaque Incision and Vein Grafting for Peyronie’s Disease: Does Time Matter?
Florian Wimpissinger, MD, FEBU, MBA; Arie Parnham, MBChB, FRCS (Urol); Georg Gutjahr, MD; Sandra Maksys, MD; Martin Baierlein, MD, FEBU; Walter Stackl, MD
ONLINE: January 2016 – The Journal of Sexual Medicine
Peyronie’s disease (PD) is a fibrotic healing disorder of the tunica albuginea of the penis. The cause of the condition is unknown.
The condition occurs in two phases. The first phase is marked by pain, tenderness, and a curving of the penis. During the second phase, pain usually improves and the deformity stabilizes.
Men with PD often have trouble penetrating a partner and may experience pain during intercourse. Penile shortening and erectile dysfunction (ED) are also common.
Surgical treatment usually involves different techniques to either pull the elongated side in (plication), incise the scarred region (incision / excision with or without grafting), or place a penile prosthesis. Candidates for surgery are chosen based on the degree of curvature and presence of ED. Results of surgery are variable, and the majority of studies have short follow-up periods.
This study aimed to examine the influence of age, comorbidities, severity of disease, and natural history of PD on patients’ long term outcomes and satisfaction after plaque incision and vein grafting for PD. The research included a minimum of 10 years of follow-up.
Patients who had PD surgery from 1992 on were prospectively evaluated for anatomical and functional factors before and after surgery. Between 2011 and 2015, patients were re-evaluated for PD recurrence and surgical outcomes. The study included patients with a follow-up of 10 years or more.
All patients underwent plaque incision and grafting. At the time of surgery, the men had had stable PD for 6 months and had a penile curvature of at least 40 degrees.
Data were collected from the time of surgery, including age and PD-related comorbidities (diabetes mellitus, Dupuytren’s contracture, and carpal tunnel syndrome). Other data included the following:
• Operative data specific to the surgical procedure.
• Postoperative follow-up data, such as the degree of curvature after surgery, development of ED, improvement of sexual function, penile shortening, PD recurrence, hyposensitivity, and overall satisfaction.
• Postoperative improvement of sexual function, self-reported by patients.
• Overall satisfaction, rated by patients on a 0% (“very dissatisfied”) to 100% (“very strong improvement”) scale.
• Penile deviation, assessed by cavernous injection of prostaglandin. Patients reported changes in penile length.
Results and Discussion
Thirty patients were evaluated in this study. Median age at surgery was 57.5 years. Preoperative angle of curvature ranged from 40 degrees to 110 degrees.
The mean follow-up period was 13 years (range: 10 to 17.6 years). At the time of follow-up, 86.7% of the men had a straight penis on erection, and 13.3% had a curve of less than 10 degrees, with the exception of one patient who had a 45 degree curve, but only one had a deviation greater than 10 degrees.
After surgery, 36.7% of patients developed new onset ED. Two of those patients had undergone radical prostatectomy and radiotherapy. Medical therapy was successful in about half of the men with ED. Five patients were sexually inactive at follow-up. Overall, 83% of the men were still able to have intercourse (with or without medication)
The mean improvement in sexual function was 69%. Almost a quarter of the men had no improvement.
Twenty-three percent had a recurrence of PD, including new plaque formation. However, these plaques did not correlate with ED or decrease satisfaction with the surgery.
Forty-three percent of the men said they had lost penile length, and 21% of the patients experienced reduced penile/glans sensitivity. Overall, 73% of men felt satisfied with the procedure.
The authors identified the following limitations:
• Erectile function was not assessed with a validated score, as this was not accepted practice in 1992, when the study began. Men who underwent surgery had “good erectile function” and an active sex life, however.
• Penile length was not measured before or after surgery. Changes in length were reported by the patients themselves, but patients’ perceptions can influence their overall satisfaction.
Plaque incision and autologous vein grafting is a “safe and effective” treatment for PD in men with severe curvature and good erectile function. Curve correction remains “durable over many years.”
“ED, penile length, and overall satisfaction seem to be negatively impacted by longer follow-up times, where the natural history of PD and comorbidities play an important role,” the authors wrote.