Kendirci Muammer, Hellstrom Wayne J G
Department of Urology, Section of Andrology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-42 New Orleans, LA 70112, USA.
Curr Opin Urol. 2004 Nov;14(6):381-8. doi: 10.1097/00042307-200411000-00015.
This review focuses on the surgical management of Peyronie's disease in the light of recent published reports from 2003 and 2004.
Although there have been a number of non-surgical innovations in this field, the surgical treatment of Peyronie's disease still remains the only alternative for patients not responding to other therapies. Various surgical modalities have recently been promulgated, however the ideal surgical procedure is still not perfected, particularly in cases of severe and complex penile curvature. The recent results of various surgical approaches have engendered concern about their long term benefits.
The initial management of the acute presentation of Peyronie's disease is conservative and non-surgical. Surgery for Peyronie's disease is contemplated only after stabilization of the fibrotic process, and is generally reserved for men with severe penile deformities that impede satisfactory sexual intercourse. If there is ample penile length and the deformity is mild to moderate in severity, a variety of plication techniques may be considered to provide a straight and functional penis. In patients with larger plaques, severe curvature, complete or hourglass deformities, then incision or excision of the plaque and the placement of a graft are recommended. Most authorities currently favor non-synthetic graft materials whose properties resemble the anatomy and functionality of the tunica albuginea. The implantation of a penile prosthesis, with or without excision/incision of the diseased tunica albuginea, is reserved for patients with erectile dysfunction who have not responded to medical therapies. Manual modeling of the deformed penis over a penile prosthesis may prevent some patients from needing more complex surgical grafting procedures.
本综述根据2003年和2004年最近发表的报告，重点关注佩罗尼氏病的外科治疗。
尽管该领域有许多非手术创新，但佩罗尼氏病的外科治疗仍然是对其他治疗无反应患者的唯一选择。最近公布了各种手术方式，然而理想的手术方法仍未完善，特别是在严重和复杂阴茎弯曲的病例中。各种手术方法的近期结果引发了对其长期益处的关注。
佩罗尼氏病急性表现的初始治疗是保守的非手术治疗。仅在纤维化过程稳定后才考虑对佩罗尼氏病进行手术，并且通常仅适用于阴茎严重畸形妨碍满意性交的男性。如果阴茎长度足够且畸形程度为轻度至中度，可以考虑采用各种折叠技术来获得笔直且功能正常的阴茎。对于斑块较大、弯曲严重、完全或沙漏形畸形的患者，建议切除或切开斑块并植入移植物。目前大多数权威人士倾向于使用性质类似于白膜解剖结构和功能的非合成移植物材料。对于对药物治疗无反应的勃起功能障碍患者，可在切除/切开患病白膜的情况下或不切除/切开的情况下植入阴茎假体。在阴茎假体上手动塑造变形阴茎可能会使一些患者无需进行更复杂的手术移植程序。
