Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Sex Med. 2018 Oct;15(10):1498-1505. doi: 10.1016/j.jsxm.2018.08.006. Epub 2018 Sep 15.
Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities.
To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities.
We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone.
Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5.
Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3-84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P < .001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P < .001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P = .84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P > .1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P = .9) and post-operatively (19.4 vs 17.6, respectively, P = .15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P = .01) and pre-operative IIEF (odds ratio 1.14, P = .02).
PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature.
STRENGTH & LIMITATIONS: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire.
Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498-1505.
阴茎折叠术（PP）是治疗轻度至中度弯曲的公认治疗选择，但关于其在严重畸形中的应用的数据很少。
比较严重和轻度/中度阴茎畸形患者接受 PD 治疗的长期结果。
我们回顾性分析了 2009 年至 2017 年间接受 PD 治疗的接受 PP 的患者。所有患者均接受多次平行的带折叠术，无需脱套。严重 PD 定义为曲率≥60 度或双平面曲率≥35 度。分析患者的人口统计学和手术结果。通过电话进行改良 PD 问卷和国际勃起功能指数（IIEF）-5 调查。
从改良问卷调查中评估长期患者报告的结果，该问卷结合了 PD 问卷和 IIEF-5。
在接受电话调查的 327 例 PP 患者中，102 例（31%）在手术 59.5 个月（中位数，28.3-84）后做出了回应。患者在严重（n=51）和轻度/中度（n=51）组之间均匀分布。尽管严重患者的平均弯曲程度明显大于轻度/中度患者（分别为 71.6 度和 37.7 度，P<.001），但在 91%的患者中实现了阴茎弯曲的矫正，严重病例的平均矫正程度为 60.7 度，轻度/中度病例为 31.4 度（P<.001）。严重和轻度/中度组中，同样数量的患者报告了阴茎弯曲的改善（74.5%比 74.5%，P=1.0）和性功能改善（51.0%比 49.0%，P=0.84）。严重和轻度/中度患者的 PD 问卷指标也相似（P>.1），主观阴茎缩短率（62.7%比 62.7%，P=1.0）和 IIEF-5 也是如此，术前分别为 19.5 比 19.7（P=0.9）和术后分别为 19.4 比 17.6（分别，P=0.15）。多元逻辑回归显示，性功能恶化与年龄增加（优势比 1.07，P=0.01）和术前 IIEF（优势比 1.14，P=0.02）显著相关。
对于严重畸形的 PD 患者，应考虑进行 PP，因为结果是有利的，与轻度弯曲的患者相当。
这是一项评估 PP 后长期患者报告结果的新研究，将严重畸形患者与轻度/中度弯曲患者进行了比较。该研究受到回顾性设计、相对较低的调查响应率（31%）以及缺乏经过验证的术后 PD 问卷的限制。
对于严重 PD 畸形的患者，PP 的长期患者报告结果与轻度/中度病例相当，支持将 PP 应用于更广泛的轻度畸形。
