title: A critical analysis of the surgical outcomes for the treatment of Peyronie's disease.
abstract: Peyronie's disease (PD) is a relatively common condition, which can impair sexual function and result in emotional and psychological distress. Despite an abundance of minimally invasive treatments, few have confirmed efficacy for improving penile curvature and function. Surgical therapies include many different techniques and are reserved for patients with stable disease of ⩾12 months' duration. We searched PubMed for all articles from 1990 to the present relating to the surgical management of PD. Preference was given to recent articles, larger series, and those comparing various techniques and/or materials. Outcomes were subsequently analysed and organised by surgical technique and the graft material used. Available surgical techniques include plication/corporoplasty procedures, incision and grafting (I&G), and placing a penile prosthesis with or without adjunctive procedures. Although several surgical algorithms have been reported, in general, plication/corporoplasty procedures are reserved for patients with adequate erectile function, simple curvatures of <60°, and with no deformities (hour-glass, hinge). I&G are reserved for complex curvatures of >60° and those with deformities. Penile prostheses are indicated for combined erectile dysfunction and PD. Overall outcomes show high rates of improved curvature and patient satisfaction, with mildly decreased erectile function with both plication and the I&G procedure (I&G >plication) and decreases in penile length (plication >I&G). Surgical management of PD remains an excellent treatment option for patients with penile curvature precluding or impairing sexual activity. Surgical algorithms are available to assist treating clinicians in appropriately stratifying surgical candidates. Additional research is needed to identify optimal surgical techniques and materials based on patient and disease characteristics.
authors.affiliation: Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Sree H
authors.initials: SH
authors.lastname: Mandava
authors.affiliation: Tulane University Medical Center, New Orleans, LA, USA ; Mayo Clinic Rochester, MN, USA.
authors.forename: Landon W
authors.initials: LW
authors.lastname: Trost
authors.affiliation: Tulane University Medical Center, New Orleans, LA, USA.
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
keywords: DM, diabetes mellitus; DUS, Doppler ultrasonography; Graft; I&G, incision and grafting; IIEF, international index of erectile function; PD, Peyronie’s disease; PDE5I, phosphodiesterase-5 inhibitors; Peyronie’s disease; Plication; Prosthesis; SIS, small intestinal submucosa; Surgical penile straightening