Egydio Paulo H
Urology Institute, Rua Iguatemi, 192 cj. 42, Sao Paulo 01451-010, Brazil.
Asian J Androl. 2008 Jan;10(1):158-66. doi: 10.1111/j.1745-7262.2008.00374.x.
To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie's disease.
Recent advances in approaches to Peyronie's disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction (ED), and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years (32-69 years) and the mean angle of curvature 74.2+/-22.4 degree (0-100 degree). Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 +/- 5.9 months (3-22 months).
Mean functional penile length gain was 3.40+/-0.73 cm (2-5 cm). Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem.
Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis (length and rigidity). Length and girth restoration is very important for self-esteem and patient satisfaction.
探讨佩罗尼氏病手术治疗后病史、术前评估、实际期望以及合适手术方式选择等要点，以提高患者满意度。
基于文献和个人经验，讨论佩罗尼氏病治疗方法的最新进展。讨论手术指征、患者选择、手术技术和移植等问题。从重建角度来看，通过移植在阴茎弯曲凸侧进行延长手术能获得最大程度的改善。阴茎矫正和硬度对于实现阴茎完全功能至关重要。大多数患者伴有勃起功能障碍（ED），仅阴茎矫直可能不足以恢复完全功能。25例患者接受了阴茎长度和周长的全阴茎重建并同时植入阴茎假体。实现了最大长度恢复，且受解剖的神经血管束长度限制。平均年龄为55.4岁（32 - 69岁），平均弯曲角度为74.2±22.4度（0 - 100度）。采用心包移植覆盖缺损。平均随访时间为11.2±5.9个月（3 - 22个月）。
阴茎功能长度平均增加3.40±0.73厘米（2 - 5厘米）。阴茎假体保持阴茎挺直。未发生感染。所有患者均恢复了性交，且均报告自尊心恢复。
提高手术治疗患者满意度包括对稳定疾病、阴茎缩短、血管和勃起状态进行适当的术前评估，患者决策和选择，以及就恢复功能性阴茎（长度和硬度）的手术技术进行广泛讨论。长度和周长恢复对自尊心和患者满意度非常重要。
