title: Erectile dysfunction following surgical correction of Peyronie's disease and a pilot study of the use of sildenafil citrate rehabilitation for postoperative erectile dysfunction.
abstract: BACKGROUND
  Peyronie's disease (PD) is correctable by several surgical approaches including plaque incision with grafting. While the best choice of graft material remains controversial, the risk of postoperative erectile dysfunction (ED) is apparent across previous reports.
  
  
  OBJECTIVE
  We attempt to provide guidelines as to which patients may be at increased risk for developing postoperative ED after this procedure, as well as examine the role of sildenafil citrate (SC) in the postoperative period for prevention of this complication.
  
  
  METHODS
  A retrospective review was performed on 37 patients who underwent surgical correction of PD with pericardial grafting after plaque incision. Mean follow-up was 24 months. We evaluated patient age, duration of disease, defect size, plaque location, degree of curvature, shaft narrowing, preoperative coital activity, vascular risk factors for ED, as well as preoperative erection grade and duplex ultrasound parameters. Twenty-six of these patients underwent a postoperative rehabilitation protocol of SC to enhance recovery of unassisted erections.
  
  
  RESULTS
  Overall, 11 patients (29%) noted diminished postoperative rigidity, that compromised unassisted coitus, compared to preoperative status. Comparison of rates of ED among those with or without vascular risk factors yielded no statistically significant results. Peyronie's disease duration, patient age, defect size, plaque location, degree of curvature, and narrowing were also insignificant predictors of which patients developed ED. An increased percentage of patients who developed ED were not sexually active preoperatively compared to those that did not develop ED (58% vs. 80%). When patients were compared based on preoperative erection grade, those patients with compromised erectile function were more likely to develop postoperative ED vs. those with full erections (P < 0.05). No significant differences were found in preoperative duplex ultrasound parameters between both sets of patients. For those undergoing SC rehabilitation, 7 out of 26 (26%) developed ED in comparison to 4 out of 11 patients (36%) developing diminished rigidity when not subjected to the protocol.
  
  
  CONCLUSIONS
  No single parameter was found that predicted the occurrence of postoperative ED with the exception of preoperative erectile status. The surgeon must carefully assess and consult each patient when considering grafting as well as consider the possible role of SC in attempting to prevent this complication.
authors.affiliation: Section of Urology, Rush University Medical Center, Chicago, IL, USA. drlevine@hotmail.com
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Levine
authors.forename: Jason M
authors.initials: JM
authors.lastname: Greenfield
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Estrada
mesh_terms: D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000037:antagonists & inhibitors; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000601:surgery*; D010496:Pericardium / Q000637:transplantation; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011687:Purines; D012189:Retrospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D000068677:Sildenafil Citrate; D013450:Sulfones
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D015106:3',5'-Cyclic-GMP Phosphodiesterases