Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Department of Urology, Rush University Medical Center, Chicago, IL, USA.
J Sex Med. 2018 Jul;15(7):1021-1029. doi: 10.1016/j.jsxm.2018.04.642. Epub 2018 May 22.
There are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening (<20 degrees).
This study highlights the clinical distinction and our experience with men with PD and severe compound curvature treated with PEG and supplemental tunica albuginea plication (TAP).
We performed a retrospective chart review of patients with PD and acute angulation who underwent PEG (group 1) and patients with compound curvature who underwent PEG with TAP (group 2) between 2007 and 2016.
Primary post-operative outcomes of interest include change in penile curvature, change in measured stretched penile length, and subjective report on penile sensation and sexually induced penile rigidity.
240 Men with PD were included in the study, of which 79 (33%) patients in group 1 underwent PEG and 161 (67%) in group 2 underwent PEG and TAP. There was no difference in associated PD co-morbidities including age, hypertension, hyperlipidemia, hypogonadism, diabetes, or tobacco use. After artificial induction of erection with intracorporal trimix injection, the average primary curvature was 73 (range, 20-120) degrees for group 1 compared to 79 (range, 35-140) degrees for group 2 (P = .01). Group 2 had an average secondary curvature of 36 (20-80 degrees). After completion of PEG, men in group 2 had an average residual curvature of 30 (range, 20-50) degrees which required 1-6 TAPs to achieve functional straightness (<20 degrees). At an average follow-up of 61 months, there was no difference for group 1 and group 2, respectively, for recurrent curvature (11.4% vs 12.4%, P = .33), change in penile length (+0.57 vs +0.36 cm, P = .27) or decreased penile sensation (6% vs 13%, P = .12). In all, 81% of group 1 and 79% of group 2 were able to engage in penetrative sex after penile straightening with or without pharmacotherapy (P = .73).
Our review shows promising surgical outcomes for the use of PEG and supplemental TAP for this subtype of complex PD.
This article reports the largest experience with treatment of PD with compound curvature to date. Limitations of this study include the retrospective nature of the analysis as well as the lack of a validated objective measurement of erectile function after penile straightening.
Our study found no baseline difference in underlying co-morbidities in men with severe compound curvature compared with men with acute severe angulated curvature. Men with severe compound curvature represent a severe and under-recognized population of men with PD who can be surgically corrected with PEG and supplemental TAP(s) when needed without an increased risk of loss of penile length, recurrent curvature, decreased penile sensation, or erectile dysfunction when compared to men treated with PEG alone. Chow AK, Sidelsky SA, Levine LA. Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature. J Sex Med 2018;15:1021-1029.
文献中关于严重复合弯曲型 Peyronie 病（PD）的治疗数据有限，通常需要在斑块切除和移植物（PEG）后进行额外的拉直手术，以实现功能阴茎伸直（<20 度）。
本研究强调了临床差异，并介绍了我们在使用 PEG 和补充白膜折叠术（TAP）治疗严重复合弯曲型 PD 患者的经验。
我们对 2007 年至 2016 年间接受 PEG（第 1 组）和接受 PEG 和 TAP（第 2 组）治疗的急性成角 PD 患者进行了回顾性图表审查。
共有 240 名 PD 男性患者纳入研究，其中第 1 组 79 名（33%）患者接受 PEG，第 2 组 161 名（67%）患者接受 PEG 和 TAP。与第 1 组相比，第 2 组在伴 PD 共病方面无差异，包括年龄、高血压、高血脂、性腺功能减退症、糖尿病或吸烟。在用腔内三联注射剂人工诱导勃起后，第 1 组的平均原发性曲率为 73（范围，20-120）度，第 2 组为 79（范围，35-140）度（P=.01）。第 2 组的平均继发性曲率为 36（20-80 度）。完成 PEG 后，第 2 组的男性平均残余曲率为 30（范围，20-50）度，需要 1-6 个 TAP 才能达到功能直线度（<20 度）。平均随访 61 个月后，第 1 组和第 2 组的复发性曲率分别为 11.4%和 12.4%（P=.33）、阴茎长度变化（+0.57 比+0.36cm，P=.27）或阴茎感觉减退（6%比 13%，P=.12）无差异。在所有患者中，第 1 组和第 2 组分别有 81%和 79%的患者在阴茎伸直后能够进行有或无药物治疗的穿透性性交（P=.73）。
我们的回顾性研究显示，PEG 和补充 TAP 治疗这种复杂 PD 亚型的手术效果有很大的前景。
本文报道了迄今为止治疗 PD 复合弯曲的最大经验。本研究的局限性包括分析的回顾性性质以及缺乏对阴茎伸直后勃起功能的客观有效测量。
我们的研究发现，与急性严重成角曲率的男性相比，严重复合弯曲的男性在潜在伴 PD 共病方面没有基线差异。严重复合弯曲的男性代表了一个严重且被低估的 PD 人群，当需要时，可以通过 PEG 和补充 TAP（如果需要）进行手术矫正，与单独接受 PEG 治疗的男性相比，不会增加阴茎长度丢失、复发性曲率、阴茎感觉减退或勃起功能障碍的风险。Chow AK、Sidelsky SA、Levine LA。严重复合弯曲型 Peyronie 病的斑块切除和移植物与补充白膜折叠术治疗的手术结果。J 性医学 2018；15：1021-1029。
