title: A prospective multicentric international study on the surgical outcomes and patients' satisfaction rates of the 'sliding' technique for end-stage Peyronie's disease with severe shortening of the penis and erectile dysfunction.
abstract: OBJECTIVE
  To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the 'sliding' technique (ST).
  
  
  METHODS
  From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end-stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Questions 2 and 3, and the Peyronie's disease questionnaire (PDQ) were completed preoperatively by all patients. At the follow-up visits (at 3, 6 and 12 months), the IIEF, the SEP Questions 2 and 3, the PDQ, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were completed. The outcome analysis was focused on penile length restoration, and intra- and postoperative complications classified according the Clavien-Dindo Classification.
  
  
  RESULTS
  The mean (range) follow-up was 37 (9-60) months. A malleable penile prosthesis (PP) was implanted in seven patients, while an inflatable three-pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen-fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II) and PP infection requiring the removal of the device (7%) (Grade III). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5-4) cm and no patient reported recurrence of the curvature.
  
  
  CONCLUSIONS
  The present series suggests that, in the hands of experienced high-volume surgeons, penile length restoration with the use of the ST represents an effective option for end-stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow-up will be required to fully establish the efficacy of this procedure.
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rolle
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.|St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceruti
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Timpano
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Omid
authors.initials: O
authors.lastname: Sedigh
authors.affiliation: St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Franklin
authors.initials: F
authors.lastname: Kuehhas
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Oderda
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Preto
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Sibona
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Gillo
authors.affiliation: St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), London, UK.
authors.forename: Giulio
authors.initials: G
authors.lastname: Garaffa
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology, Città della Salute e della Scienza, University of Turin , Turin, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019935:Penile Implantation / Q000009:adverse effects / Q000379:methods*; D010411:Penile Induration / Q000150:complications* / Q000601:surgery*; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D016459:Prosthesis-Related Infections; D016896:Treatment Outcome
keywords: Peyronie's disease; erectile dysfunction; patch graft surgery for Peyronie's disease; penile lengthening; penile prosthesis