Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; AndroUrology Centre, Brisbane, QLD, Australia.
Division of Urology, University of Texas Health Science Centre, Houston, TX, USA.
J Sex Med. 2018 Apr;15(4):568-575. doi: 10.1016/j.jsxm.2018.01.025. Epub 2018 Mar 14.
Despite published guidelines on Peyronie's disease (PD), there are limited data on actual surgical practice among surgeons.
To evaluate the surgical practice patterns in PD among surgeons from different continents and members of various sexual medicine societies.
An anonymous survey on various pre-, intra-, and postoperative aspects of PD surgical care was distributed in printed format during International Society of Sexual Medicine meetings and as an online survey to International Society of Sexual Medicine members.
390 surgeons responded to the survey, with great variations in pre-, intra-, and postoperative strategies in PD surgical care.
Most surgeons performed fewer than 10 penile plications and 10 graft surgeries per year. Modified Nesbit plication was the preferred option by most surgeons. Surgeons who received fellowship training were more likely to perform autologous than allograft surgery (odds ratio = 1.79, 95% CI = 1.13-2.82, P = .01). The use of penile color duplex ultrasound was inconsistently performed, with higher-volume surgeons (ie, >20 cases operated a year) more likely to use this diagnostic modality (odds ratio = 70.18, 95% CI = 20.99-234.6, P < .001). Most surgeons agreed that surgical intervention should be performed only after a 6-month history of stable penile curvature, although higher-volume surgeons were more inclined to perform surgery sooner (P = .08).
Although it is unknown whether variations in PD surgery significantly affect clinical outcome and patient satisfaction rate, this worldwide survey study has the potential to assist in the formation of a new practice guideline and serve as the basis for future prospective multinational studies.
This is one of the largest surveys on PD practice and, to our knowledge, the only survey conducted across various sexual medicine societies, with the inclusion of many high-volume and experienced PD surgeons. This also is the 1st study to comprehensively evaluate many key aspects in surgical practice patterns for PD. However, the categorization on the questionnaire used in this survey was not designed to allow for direct comparison given the possibility of some surgeons with dual society memberships, reporting biases, large CIs in outcomes, different patient demographics, and cultural acceptance.
There is great variation in surgical practice patterns in PD management, including key differences among surgeons across different continents and sexual medicine societies. Chung E, Wang R, Ralph D, et al. A Worldwide Survey on Peyronie's Disease Surgical Practice Patterns Among Surgeons. J Sex Med 2018;15:568-575.
尽管已经发布了关于 Peyronie 病（PD）的指南，但关于外科医生实际手术实践的数据有限。
评估来自不同大洲的外科医生和各种性医学学会成员在 PD 手术中的手术实践模式。
在国际性学会会议期间以印刷形式和作为在线调查向国际性学会成员分发了一份关于 PD 手术护理的各种术前、术中和术后方面的匿名调查。
390 名外科医生对调查做出了回应，在 PD 手术护理的术前、术中和术后策略方面存在很大差异。
大多数外科医生每年进行的阴茎折叠术和移植物手术少于 10 例。大多数外科医生更喜欢改良的 Nesbit 折叠术。接受过专业培训的外科医生更有可能进行自体移植物手术而不是同种异体移植物手术（比值比= 1.79，95%置信区间= 1.13-2.82，P =.01）。使用阴茎彩色双功能超声的情况不一致，手术量较大的外科医生（即每年操作> 20 例）更可能使用这种诊断方式（比值比= 70.18，95%置信区间= 20.99-234.6，P <.001）。大多数外科医生同意仅在稳定的阴茎弯曲病史 6 个月后才应进行手术干预，尽管手术量较大的外科医生更倾向于更早进行手术（P =.08）。
尽管尚不清楚 PD 手术的差异是否会显著影响临床结果和患者满意度，但这项全球范围的调查研究有可能有助于制定新的实践指南，并为未来的多中心前瞻性研究提供基础。
这是 PD 实践的最大调查之一，并且据我们所知，这是唯一在各个性医学学会中进行的调查，其中包括许多高容量和经验丰富的 PD 外科医生。这也是第一项全面评估 PD 手术实践模式中许多关键方面的研究。但是，由于一些外科医生可能具有双重学会会员资格，报告偏见，结果的置信区间较大，患者人群不同以及文化接受度等原因，该调查问卷的分类设计并不能进行直接比较。
在 PD 管理的手术实践模式中存在很大差异，包括不同大洲和性医学学会之间的外科医生之间的关键差异。
