title: Effect of tunical defect size after Peyronie's plaque excision on postoperative erectile function: do centimeters matter?
abstract: OBJECTIVE
  To demonstrate the effect of the size of the resultant tunical defect after plaque excision on postoperative erectile function of patients with Peyronie's disease.
  
  
  METHODS
  The results of 38 patients with plaque excision and dermal grafting were reviewed from April 2007 to June 2011. History, physical examination, self-shot photograph, color duplex ultrasonography were done preoperatively, and the risk factors for erectile dysfunction were evaluated. The tunical defects were ≥ 3 cm for group 1 and <3 cm for group 2. The postoperative need for phosphodiesterase type 5 inhibitors was noted for both groups. The International Index of Erectile Function-5 questionnaire was completed by all patients.
  
  
  RESULTS
  Overall, phosphodiesterase type 5 inhibitors were necessary for 13 (34%) of 38 patients; 7 (58.3%) of 12 in group 1 and 6 (23%) of 26 in group 2. The risk factors for postoperative erectile dysfunction were statistically similar for both groups. If patients with ventral defects were excluded from group 2, the number of patients requiring phosphodiesterase type 5 inhibitors was 4 (17%) of 24. The patients in group 2 answered the fifth question (4.6 ± 0.55) significantly different from those in group 1 (3.7 ± 0.88).
  
  
  CONCLUSIONS
  Plaque excision and dermal grafting can be recommended only for highly selected patients with Peyronie's disease with good erectile capacity, with a degree of angle not suitable for only plication or Nesbit techniques, for patients who do not accept any significant shortening of the penis, and if the size of the tunical defect will be <3 cm. Additional techniques on the opposite aspect of the lesion are advocated for the remaining curvatures, not to enlarge the tunical defect >3 cm.
authors.affiliation: Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey. drzafko@hotmail.com
authors.forename: Zafer
authors.initials: Z
authors.lastname: Kozacioglu
authors.forename: Tansu
authors.initials: T
authors.lastname: Degirmenci
authors.forename: Bulent
authors.initials: B
authors.lastname: Gunlusoy
authors.forename: Cengiz
authors.initials: C
authors.lastname: Kara
authors.forename: Murat
authors.initials: M
authors.lastname: Arslan
authors.forename: Yasin
authors.initials: Y
authors.lastname: Ceylan
authors.forename: Suleyman
authors.initials: S
authors.lastname: Minareci
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection / Q000502:physiology*; D010411:Penile Induration / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010413:Penis / Q000033:anatomy & histology* / Q000502:physiology; D011184:Postoperative Period; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome