Is Kelami’s Method Still Useful in the Smartphone Era? The Virtual 3-Dimensional Reconstruction of Penile Curvature in Patients With Peyronie’s Disease: A Pilot Study
Carlo Pavone MD; Alberto Abrate MD; Silvia Altomare MD; Marco Vella MD; Vincenzo Serretta MD, PhD; Alchiede Simonato MD; Marco Callieri PhD
FIRST PUBLISHED: November 13, 2020 – The Journal of Sexual Medicine
The gold standard approach for evaluating penile curvature in men with Peyronie’s disease is an “in-office goniometric estimation after a pharmacologically induced erection.” However, this approach can be invasive and uncomfortable, and new methods are needed.
One proposed alternative uses photographs and computer software to create a 3-dimensional (3-D) reconstruction of penile curvature. The current pilot study discusses the feasibility of this approach and the satisfaction of patients and surgeons who use the model for preoperative counseling and planning.
Materials and Methods
The study included 4 men with Peyronie’s disease who were due to be treated surgically at the University Hospital of Palermo.
At their first visit, the men were physically examined and answered questions about symptoms. They also completed the International Index of Erectile Function-5 (IIEF-5).
At their second visit, each man had an erection induced through intracavernous injection with alprostadil. Once maximum rigidity was achieved, a researcher used a smartphone to take photographs of the men’s groin area while the men were standing. At least fifty photographs were taken of each patient.
Three online software packages were used to create a penis model:
- 3DF Zephyr software generated a preoperative 3-D model.
- MeshLab software measured penile curvature.
- Blender software created a second 3-D model that simulated results after corporoplasty.
Three models from 3 independent photographic sets were created for each patient.
Corporoplasty was performed using the Nesbit procedure.
After surgery, patients and surgeons used Likert scales to express their personal impressions in regard to the utility of the 3-D model for:
- preoperative counseling
- surgical planning
- esthetic results compared with the preoperative model
The four men who participated in the study had a median age of 62.5 years. Their median calculated curvature angle was 39.5 degrees.
The median time to process raw images, reconstruct 3-D models, measure penile curvature, and plan surgical interventions was 347.5 minutes.
Surgeons judged the 3-D model to be “realistic” and “very useful” for counseling and surgical planning.
All patients also considered the model “realistic” and “useful” for understanding Peyronie’s disease and their surgery.
Both surgeons and patients were satisfied with the final result of surgery and referred it was similar to the pre-operative 3-D simulation of post-operative aspect
Median Likert scores for each assessed item were as follows (ratings are from 1= very unsatisfied to 5 = very satisfied):
|Surgeons’ Scores||Patients’ Scores|
|Final Esthetic Results||4||4.5|
The current gold standard method for assessing Peyronie’s disease is invasive and needs to be performed in “standard conditions” of erection rigidity and camera angle.
The current study showed that realistic and useful 3-D models of the penis can be created with photograph-processing software.
Using 3-D models of penile curvature and surgical correction as described in this study can help patients better understand Peyronie’s disease and the surgical methods used to treat it. It can also give them an idea of what to expect after surgery.
Several limitations were acknowledged. For example, the study sample was small, with only four patients. The findings should be confirmed with larger studies that include men with “more complex curvatures or different defects.” The use of 3-D models with other surgical techniques might also be investigated.
“The main strength of the present study is that the patient saw, understood, and shared his final hypothetic esthetic result before surgery, which is important for informed consent and any medicolegal claims.”