Papagiannopoulos Dimitri, Yura Emily, Levine Laurence
Rush University Medical Center, Chicago, IL, USA.
J Sex Med. 2015 Jun;12(6):1474-80. doi: 10.1111/jsm.12910. Epub 2015 May 15.
Surgery remains the gold standard treatment for men with stable Peyronie's disease (PD). In an attempt to guide operative selection, we report our series of penile-straightening procedures for PD, using a surgical algorithm that recommended tunica albuginea plication (TAP), partial plaque excision and grafting (PEG) or inflatable penile prosthesis (IPP) placement. With this study, we attempt to further refine surgical approach, define realistic surgical outcomes, and help establish reasonable postoperative expectations for treatment of PD.
We retrospectively reviewed all patients who underwent surgery for PD at our institution between 2007 and 2013. Work-up involved a history, physical exam, and a duplex ultrasound. Several questionnaires were employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed postoperatively. Primary outcomes include postoperative patient satisfaction with rigidity, curvature, and ability to engage in intercourse. Secondary outcomes include comparing emotional, relationship, and psychological distress to severity of disease.
A total of 390 patients underwent penile-straightening procedures for correction of PD. Of these patients, 29%, (n = 114) underwent TAP, 41% (n = 159) PEG, and 30% (N = 114) IPP. Mean follow-up was 17 months. The three surgical modalities showed no significant difference in satisfaction with penile rigidity, presence of bothersome residual curve, or ability to engage in intercourse. Preoperatively, 80% of men reported a negative effect of PD on their emotional status. Postoperatively, 88.4% of men were able to engage in penetrative intercourse, while only 70% were satisfied with rigidity and 84.9% were satisfied with curvature correction.
Patient experience with postsurgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups, supporting the use of this surgical algorithm. The majority of patients with PD experience some degree of emotional and psychological distress, which may compromise patient satisfaction.
手术仍是稳定期佩罗尼氏病（PD）男性患者的金标准治疗方法。为指导手术选择，我们报告了一系列针对PD的阴茎矫直手术，采用一种手术算法，推荐白膜折叠术（TAP）、部分斑块切除及移植术（PEG）或可膨胀阴茎假体（IPP）植入术。通过本研究，我们试图进一步优化手术方法，明确实际的手术效果，并帮助建立对PD治疗合理的术后预期。
我们回顾性分析了2007年至2013年在我院接受PD手术的所有患者。术前检查包括病史、体格检查和双功超声检查。采用几份问卷评估与PD相关的困扰和痛苦。术后评估客观结果和患者满意度。主要结果包括术后患者对阴茎硬度、弯曲度和性交能力的满意度。次要结果包括比较情绪、人际关系和心理痛苦与疾病严重程度。
共有390例患者接受了阴茎矫直手术以矫正PD。其中，29%（n = 114）接受了TAP，41%（n = 159）接受了PEG，30%（n = 114）接受了IPP。平均随访时间为17个月。三种手术方式在阴茎硬度满意度、残留烦人的弯曲度或性交能力方面无显著差异。术前，80%的男性报告PD对其情绪状态有负面影响。术后，88.4%的男性能够进行插入式性交，而只有70%的男性对硬度满意，84.9%的男性对弯曲度矫正满意。
三组患者术后阴茎硬度体验、性交能力和残留烦人的弯曲度在统计学上无差异，支持使用这种手术算法。大多数PD患者经历了一定程度的情绪和心理痛苦，这可能会影响患者满意度。
