Cormio Luigi, Zucchi Alessandro, Lorusso Fabrizio, Selvaggio Oscar, Fioretti Fabrizio, Porena Massimo, Carrieri Giuseppe
Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
Eur Urol. 2009 Jun;55(6):1469-75. doi: 10.1016/j.eururo.2008.11.041. Epub 2008 Dec 3.
Plaque incision and tunical grafting is widely used to correct penile curvatures secondary to Peyronie's disease (PD), but there is no consensus on the ideal graft to be used.
To evaluate the efficacy, safety, and reproducibility of plaque incision and buccal mucosa grafting (BMG) in the correction of severe penile curvatures secondary to PD.
DESIGN, SETTING, AND PARTICIPANTS: Fifteen patients reporting normal erections and stable curvature (>12-mo duration) entered this prospective study carried out at two university hospitals.
All patients underwent plaque incision and BMG.
Preoperative evaluation included the International Index of Erectile Function (IIEF-5) and penile duplex ultrasounds with measurement of curvature and length of affected side. Follow-up visits were scheduled at 1, 3, 6, and 12 mo postoperatively, then yearly. Three-mo postoperative evaluation included IIEF-5, patient and partner satisfaction, and intracavernous injection test with evaluation of penile rigidity, straightness, and length; patient and partner satisfaction was recorded at all subsequent visits.
Mean patient age was 56.3 yr and mean penile curvature 72 degrees ; five patients had a two-sided curvature with mean second curvature of 37 degrees . There were no complications. All patients resumed unassisted intercourse 1 mo after surgery. Three-mo postoperative evaluation showed 100% penile straightening, 1.8-cm mean increase in length of affected side, no curvature recurrence or de novo erectile dysfunction, 1.6 mean increase in IIEF-5 score, and patient and partner satisfaction of 93.3% and 100%, respectively. Although results remained stable at subsequent follow-up (mean 13.1 mo), a greater number of patients and longer follow-up are needed before drawing any definite conclusions.
BMG provided excellent short-term results, probably because its prompt revascularisation, suggested by the fast return of spontaneous erections, prevented shrinkage, which is the main cause of graft failure. It also proved to be safe and reproducible, thus representing a valuable treatment option for PD.
斑块切开及白膜移植术广泛应用于矫正佩罗尼氏病（PD）继发的阴茎弯曲，但对于理想的移植材料尚无共识。
评估斑块切开及颊黏膜移植术（BMG）矫正PD继发严重阴茎弯曲的疗效、安全性及可重复性。
设计、地点和参与者：15例勃起功能正常且弯曲稳定（持续时间>12个月）的患者进入了在两家大学医院开展的这项前瞻性研究。
所有患者均接受斑块切开及BMG手术。
术前评估包括国际勃起功能指数（IIEF-5）以及阴茎双功能超声检查，测量患侧弯曲度和长度。术后1、3、6和12个月安排随访，之后每年随访一次。术后3个月评估包括IIEF-5、患者及伴侣满意度，以及海绵体内注射试验，评估阴茎硬度、伸直度和长度；在所有后续随访中记录患者及伴侣的满意度。
患者平均年龄为56.3岁，平均阴茎弯曲度为72度；5例患者为双侧弯曲，平均第二弯曲度为37度。未发生并发症。所有患者术后1个月恢复自主性交。术后3个月评估显示阴茎完全伸直，患侧长度平均增加1.8厘米，无弯曲复发或新发勃起功能障碍，IIEF-5评分平均增加1.6分，患者及伴侣满意度分别为93.3%和100%。尽管在后续随访（平均13.1个月）中结果保持稳定，但在得出任何明确结论之前，需要更多患者和更长时间的随访。
BMG提供了出色的短期效果，这可能是因为自发勃起快速恢复提示其迅速血管化，防止了移植失败的主要原因——收缩。它还被证明是安全且可重复的，因此是PD一种有价值的治疗选择。
