Warner Jonathan Nicholas
Division of Urology and Urologic Oncology, City Of Hope, 1500 East Duarte Ave, Duarte, CA, 91010, USA.
Curr Urol Rep. 2019 Jan 30;20(2):9. doi: 10.1007/s11934-019-0870-z.
The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches.
Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. The goal of these operations is not only to correct curvature, but also to restore length. Not surprisingly, the more complex and aggressive the attempt to correct the curvature, the more complications are possible. While modeling has a low rate of urethral injury, complex lengthening procedure with neurovascular bundle and urethral mobilization may lead to the dreaded complication of glans necrosis. Meanwhile, transcorporal techniques seem to offer a more modest improvement for length and curvature restoration with fewer risks than those seen in more aggressive lengthening procedures. The main limitation to the historical treatment of Peyronie's disease during penile prosthesis, modeling, and plaque incision is there is often no resolution to the penile length-as the maneuvers are made after the implant is already in place. Newer lengthening procedures are promising, however carry increased risks and complexity.
在过去40年里，阴茎植入物用于治疗勃起功能障碍和佩罗尼氏病的方式变化不大，主要局限于塑形和斑块切开。在本综述中，我探讨了阴茎假体植入时佩罗尼氏病的治疗历史，并探索了新的手术选择，这些选择有助于解决一些传统方法无法治疗的问题。
在移植材料、延长手术和经体技术领域已取得进展。这些手术的目标不仅是矫正弯曲，还在于恢复长度。不出所料，矫正弯曲的尝试越复杂、越激进，出现的并发症就可能越多。虽然塑形导致尿道损伤的发生率较低，但带有神经血管束和尿道游离的复杂延长手术可能会导致可怕的龟头坏死并发症。与此同时，经体技术似乎在恢复长度和弯曲方面改善较小，且风险低于更激进的延长手术。阴茎假体植入、塑形和斑块切开期间佩罗尼氏病的传统治疗方法的主要局限性在于，由于手术是在植入物已经就位后进行的，阴茎长度往往无法恢复。较新的延长手术很有前景，但风险和复杂性增加。
