Section of Andrology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, 34390 Capa, Istanbul, Turkey.
Nat Rev Urol. 2011 Feb;8(2):95-106. doi: 10.1038/nrurol.2010.233.
Surgery is the standard treatment for patients in the chronic phase of Peyronie's disease. Reconstructive surgeries function by either shortening the convex side of the tunica albuginea (Nesbit procedure, Yachia technique and penile plication) or lengthening the concave side by incision of the plaque with subsequent grafting. Tunical shortening procedures are ideal for men with good erectile capacity, penile curvatures less than 60° and predicted postprocedural length loss of less than 20% of erect penis length. Tunical lengthening procedures with grafting are indicated in patients with severe penile length loss, curvatures greater than 60° and prominent hourglass deformities. Saphenous vein and tunica albuginea are the most commonly used autologous graft materials. Cadaveric or bovine pericardium and 4-layer small intestinal submucosa are promising nonautologous tissues. Penile implantation of a prosthesis is the standard procedure in men with erectile dysfunction who do not respond to conservative treatment. If residual penile curvature is less than 30° after implantation, no further treatment is required. However, residual curve of greater than 30° can be straightened with manual modeling. Additional procedures such as penile plication, the Nesbit procedure, or grafting can be performed if modeling fails to correct the residual deformity.
手术是治疗 Peyronie 病慢性期患者的标准治疗方法。重建手术的作用是通过缩短白膜的凸侧（Nesbit 手术、Yachia 技术和阴茎折叠术）或通过切开斑块并随后进行移植来延长凹侧。对于勃起功能良好、阴茎弯曲小于 60°且预计术后勃起阴茎长度损失小于 20%的男性，白膜缩短术是理想的选择。对于严重阴茎长度损失、弯曲大于 60°和明显沙漏畸形的患者，需要进行带移植物的白膜延长术。大隐静脉和白膜是最常用的自体移植物材料。同种异体组织如脱细胞异体真皮和 4 层小肠黏膜下层是有前途的非自体组织。对于对保守治疗无反应的勃起功能障碍男性，阴茎植入假体是标准程序。如果植入后阴茎残余弯曲小于 30°，则无需进一步治疗。但是，如果残余弯曲大于 30°，可以通过手动塑形来矫正。如果塑形不能纠正残余畸形，可以进行阴茎折叠术、Nesbit 手术或移植物等附加手术。
