title: Preoperative clinical and diagnostic characteristics of patients who require delayed IPP after primary Peyronies repair.
abstract: BACKGROUND
  Penile vascular abnormalities occur in a high proportion of patients with Peyronie's disease (PD). Penile duplex ultrasonography (PDU) and dynamic infusion cavernosometry and cavernosography (DICC) are tools that can be used to help tailor individualized treatment for patients undergoing surgical intervention for their PD. However, precisely which parameters can be used to predict those patients with PD at risk for developing erectile dysfunction (ED) after intervention without inflatable penile prosthesis (IPP) has not been previously elucidated.
  
  
  OBJECTIVE
  To evaluate preoperative vascular parameters that predispose PD patients for developing ED after intervention without IPP.
  
  
  METHODS
  Twenty-six patients receiving surgical intervention for their PD at a single center were retrospectively identified. Of these, 11 (42.3%) opted for primary repair without placement of an IPP. Three (27.2%) of these 11 patients went on to develop ED postoperatively.
  
  
  METHODS
  We compared various demographic, PDU, and DICC parameters between patients who did and did not fail primary repair of their PD.
  
  
  RESULTS
  Mean age and follow-up of patients who went on to develop ED after repair of PD without IPP were not significantly different (P < 0.05). Resistive index (RI) and end diastolic volume were significantly different between these two groups (P < 0.05), while peak systolic volume, flow to maintain, and pressure decay were not significantly different. An RI cutoff of <0.80 was found to identify all patients who would later develop ED and fail primary repair without IPP.
  
  
  CONCLUSIONS
  Penile vascular assessment can aid in counseling patients about their risk of developing delayed ED after primary repair of PD. In our cohort of patients, PDU provided preoperative risk stratification for postoperative erectile dysfunction in men undergoing Peyronie's repair without IPP. We propose the prospective study of an RI cutoff to identify patients at risk of failing primary PD repair without IPP.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL60611-3008, USA.
authors.forename: Hannah H
authors.initials: HH
authors.lastname: Alphs
authors.forename: Neema
authors.initials: N
authors.lastname: Navai
authors.forename: Tobias S
authors.initials: TS
authors.lastname: Köhler
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation / Q000379:methods*; D010411:Penile Induration / Q000175:diagnosis* / Q000601:surgery*; D010413:Penis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D012720:Severity of Illness Index; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex