College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Sex Med. 2011 Jul;8(7):2031-7. doi: 10.1111/j.1743-6109.2011.02299.x. Epub 2011 May 19.
Plaque incision and grafting (PIG) surgery for Peyronie's disease (PD) is a recognized management strategy. One of the recognized complications of PIG surgery is the development of postoperative erectile dysfunction (ED).
To determine the incidence of ED after PIG surgery and attempt to define predictors of ED development.
All patients underwent preoperative cavernosometry. Grafting was performed with either cadaveric pericardium (Tutoplast) or intestinal submucosa (Surgisis). Prior to 2006, the procedure used an H-type incision, whereas after this date, the Egydio approach has been used.
Men undergoing PIG completed preoperative and 6-month postoperative International Index of Erectile Function (IIEF) questionnaires.
56 patients were analyzed. Mean patient and partner ages were 57 ± 22 and 54 ± 18 years, respectively. Mean duration of PD at the time of PIG was 22 ± 9 months. Seventy-five percent had curvature alone, 11% had hourglass/indentation deformity, and the remainder had combined curvature/indentation. Mean preoperative curvature was 52 ± 23°. Fifty-two had grafting with Tutoplast, while four had grafting with Surgisis. All men at baseline were capable of generating a penetration rigidity erection. Preoperatively, 50% of men had cavernosal insufficiency and 21% had venous leak (baseline and postoperative erectile function [EF] domain scores were 23 ± 4 and 17 ± 9, respectively [P < 0.01]). Forty-six percent of men experienced a ≥6-point decrease in EF domain score after PIG. The predictors of a ≥6-point reduction in IIEF-EF domain score on multivariable analysis were degree of preoperative curvature, type of plaque incision, patient age, and baseline venous leak. Conclusions. Almost one-half of men had significant reduction in their erectile rigidity after PIG. Reduction was predicted by larger baseline curvature, the Egydio plaque incision technique, older patient age, and the presence of venous leak at baseline. Based on these data, we discourage older men, those with venous leak, and those with profound curvature from considering PIG surgery.
阴茎硬结症（PD）的斑块切开和移植（PIG）手术是一种公认的治疗策略。PIG 手术后的一种公认并发症是勃起功能障碍（ED）的发生。
确定 PIG 手术后 ED 的发生率，并尝试确定 ED 发展的预测因素。
所有患者均接受术前海绵体测压。移植采用尸体心包（Tutoplast）或肠黏膜下层（Surgisis）。2006 年之前，采用 H 型切口，之后采用 Egydio 方法。
接受 PIG 的男性患者完成术前和术后 6 个月的国际勃起功能指数（IIEF）问卷。
分析了 56 例患者。患者和伴侣的平均年龄分别为 57 ± 22 岁和 54 ± 18 岁。PIG 时 PD 的平均病程为 22 ± 9 个月。75%的患者只有弯曲畸形，11%的患者有沙漏/凹陷畸形，其余的患者有弯曲/凹陷畸形。术前平均弯曲度为 52 ± 23°。52 例患者行 Tutoplast 移植，4 例行 Surgisis 移植。所有患者基线时均能产生可穿透性硬度勃起。术前，50%的患者有海绵体功能不全，21%的患者有静脉漏（基线和术后勃起功能[EF]域评分分别为 23 ± 4 和 17 ± 9，P < 0.01）。PIG 后，46%的患者 EF 域评分下降≥6 分。多变量分析中，EF 域评分下降≥6 分的预测因素为术前弯曲度、斑块切口类型、患者年龄和基线静脉漏。结论。近一半的男性在 PIG 后勃起硬度明显下降。较大的基线弯曲度、Egydio 斑块切口技术、患者年龄较大和基线存在静脉漏是导致这种下降的预测因素。基于这些数据，我们不鼓励老年男性、静脉漏患者和严重弯曲的患者考虑 PIG 手术。
