Kadıoğlu Ateş, Salabaş Emre, Özmez Abdulkadir, Ural Abdullah Feyyaz, Yücel Ömer Barış, Ortaç Mazhar, Pazır Yaşar, Ermeç Bahadır
Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
Department of Urology, Biruni University Hospital, İstanbul, Turkey.
Turk J Urol. 2018 Jan;44(1):10-15. doi: 10.5152/tud.2018.87405. Epub 2017 Jan 1.
To assess the outcomes of the surgical techniques used in Peyronie's disease (PD) surgery.
Two hundred and sixty-eight patients received surgical treatment for PD. Fifty four and 144 patients underwent simple corporoplasties (shortening procedure, SP, group 1) or plaque incision and grafting surgery (lengthening surgery, LP, group 2), respectively, whereas 70 patients with erectile dysfunction underwent penile prosthesis implantation.
Penile plication and Nesbit surgeries were performed in 5 (9%) and 42 (78%) patients out of total 54 patients. In the remaining 7 (13%) patients, Nesbit and plication suture combination was required for complete penile straightening. Mean curvature degree was 52.2±12.3 degrees. Follow up time was 36.1±29.4 months. No significant difference was demonstrated between the two groups in the baseline features and co-morbidities except age. In 144 patients who underwent plaque incision and grafting, mean age and PD onset duration were 54.1±9.2 years and 28.2±17.3 months respectively. Mean curvature degree was 58.4±18.9 degrees. Post-operative follow up time of the second group was 51.1±39.6 months. Additional plication suture was used in 48 patients (33%) patients. Degree of curvature improvement was 37.9±19.1 and 52.1±23.5 in SP and LP respectively (p=0.01). The initial anatomic success rates were 90.4% and 87.5% at their early post-operative follow-ups for group 1 and 2 respectively. These rates dropped to 82.7% and 83.6% at the long term follow-up (36 and 51 months) respectively (p=0.9). Although the average follow-up time of LP group was longer than SP group (52.1 mo vs. 37.0 mo), recurrence rates of these two groups were comparable. The combined functional and anatomical success of patients were demonstrated to be 79% and 75% in shortening and grafting surgery. Shortening surgery was not statistically superior to grafting surgery for patients in terms of having erection with or without the aid of PDE-5 inhibitors (94.4% vs. 88.2%, p=0.28). Shortening surgery makes a difference in the long term follow-up for patients who had erections without the aid of PDE-5 inhibitors (90.7% vs. 67.3%, p=0.02).
Both SP and LP are successful in terms of penile straightening in the short and long-term follow-up. Curvature degree improvement is greater in LP. Patients who undergo LP surgery may suffer from ED in the long-term follow-ups. Greater percentage of patients who underwent LP require PDE-5 inhibitors usage for sexual intercourse. Despite stated shortcomings, combined success (anatomic and functional) is achieved in three out of four patients for both groups. Penile prosthesis implantation should be preferred for patients with ED and penile deformity.
评估佩罗尼氏病（PD）手术中所使用手术技术的疗效。
268例患者接受了PD手术治疗。其中，54例和144例患者分别接受了单纯阴茎成形术（缩短手术，SP，第1组）或斑块切开及移植手术（延长手术，LP，第2组），而70例勃起功能障碍患者接受了阴茎假体植入术。
在总共54例患者中，5例（9%）和42例（78%）分别进行了阴茎折叠术和内斯比特手术。其余7例（13%）患者需要内斯比特手术和折叠缝合相结合才能完全矫正阴茎弯曲。平均弯曲度为52.2±12.3度。随访时间为36.1±29.4个月。除年龄外，两组在基线特征和合并症方面无显著差异。在144例行斑块切开及移植手术的患者中，平均年龄和PD发病持续时间分别为54.1±9.2岁和28.2±17.3个月。平均弯曲度为58.4±18.9度。第二组术后随访时间为51.1±39.6个月。48例（33%）患者使用了额外的折叠缝合。SP组和LP组的弯曲度改善分别为37.9±19.1和52.1±23.5（p=0.01）。第1组和第2组术后早期随访时的初始解剖成功率分别为90.4%和87.5%。长期随访（36个月和51个月）时，这些成功率分别降至82.7%和83.6%（p=0.9）。尽管LP组的平均随访时间长于SP组（52.1个月对37.0个月），但两组的复发率相当。缩短手术和移植手术患者的功能与解剖综合成功率分别为79%和75%。就使用或不使用磷酸二酯酶5抑制剂（PDE-5）进行勃起而言，缩短手术在统计学上并不优于移植手术（94.4%对88.2%，p=0.28）。对于不借助PDE-5抑制剂就能勃起的患者，缩短手术在长期随访中存在差异（90.7%对67.3%，p=0.02）。
在短期和长期随访中，SP和LP在矫正阴茎弯曲方面均取得成功。LP组的弯曲度改善更大。接受LP手术的患者在长期随访中可能会出现勃起功能障碍。接受LP手术的患者中，更高比例的人需要使用PDE-5抑制剂进行性交。尽管存在上述缺点，但两组四分之三的患者都实现了综合成功（解剖和功能）。对于勃起功能障碍和阴茎畸形患者，应首选阴茎假体植入术。
