title: Examining Postoperative Outcomes after Employing a Surgical Algorithm for Management of Peyronie's Disease: A Single-Institution Retrospective Review.
abstract: OBJECTIVE
  Surgery remains the gold standard treatment for men with stable Peyronie's disease (PD). In an attempt to guide operative selection, we report our series of penile-straightening procedures for PD, using a surgical algorithm that recommended tunica albuginea plication (TAP), partial plaque excision and grafting (PEG) or inflatable penile prosthesis (IPP) placement. With this study, we attempt to further refine surgical approach, define realistic surgical outcomes, and help establish reasonable postoperative expectations for treatment of PD.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent surgery for PD at our institution between 2007 and 2013. Work-up involved a history, physical exam, and a duplex ultrasound. Several questionnaires were employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed postoperatively. Primary outcomes include postoperative patient satisfaction with rigidity, curvature, and ability to engage in intercourse. Secondary outcomes include comparing emotional, relationship, and psychological distress to severity of disease.
  
  
  RESULTS
  A total of 390 patients underwent penile-straightening procedures for correction of PD. Of these patients, 29%, (n = 114) underwent TAP, 41% (n = 159) PEG, and 30% (N = 114) IPP. Mean follow-up was 17 months. The three surgical modalities showed no significant difference in satisfaction with penile rigidity, presence of bothersome residual curve, or ability to engage in intercourse. Preoperatively, 80% of men reported a negative effect of PD on their emotional status. Postoperatively, 88.4% of men were able to engage in penetrative intercourse, while only 70% were satisfied with rigidity and 84.9% were satisfied with curvature correction.
  
  
  CONCLUSIONS
  Patient experience with postsurgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups, supporting the use of this surgical algorithm. The majority of patients with PD experience some degree of emotional and psychological distress, which may compromise patient satisfaction.
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Papagiannopoulos
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Yura
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Levine
mesh_terms: D000328:Adult; D000465:Algorithms; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010411:Penile Induration / Q000601:surgery*; D015917:Penile Prosthesis; D010413:Penis / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D018616:Ultrasonography, Doppler, Duplex
keywords: Grafting; Penile Prosthesis; Peyronie's Disease; Surgical Algorithms; Tunica Albuginea Plication