Urology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain.
J Sex Med. 2019 Feb;16(2):323-332. doi: 10.1016/j.jsxm.2018.11.014.
Patients with Peyronie's disease (PD) and erectile dysfunction (ED) concomitant with shortening or other malformations benefit from prosthesis implantation and penile lengthening procedures.
To evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening.
From February 2015-May 2018, 43 consecutive patients with complex PD were treated using this technique. Implantation of a penile prosthesis (malleable or inflatable [IPP]) together with multiple relaxing tunica albuginea incisions and grafting with a self-adhesive collagen-fibrin fleece (TachoSil, Baxter Healthcare) was performed in all patients by a single surgeon (J.I.M.S.).
Penile length and curvature correction, operative time, and incidence of postoperative complications were recorded as outcome measures. Functional outcomes were measured with questionnaires (International Index of Erectile Function-5, Erection Hardness Score, modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, PD Questionnaire) before and 3 and 6 months after surgery.
With a median follow-up of 21 months (range 10-31), mean postsurgical penile lengthening was 2.5 (range 1-5) cm, with an improvement in the Bother domain of the PD Questionnaire of 4.4 (range 2-5) points. The average operative time was 86.7 and 71.6 minutes for the IPP and malleable penile prosthesis procedure, respectively. No glans ischemia was recorded; however, 1 IPP infection and 1 delayed distal corporeal erosion were recorded. Hematoma or bruising was observed in 23.2% of patients. The modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was completed by 39 (90.7%) patients. Overall, 89.7% would recommend this surgery. Patient satisfaction with straightness and length was 94.9% and 82.1%, respectively.
The described technique helps restoration of penile length and erectile function in patients with complex PD.
STRENGTHS & LIMITATIONS: The strength of the study is that it offers a simple, easy-to-apply technique for surgeons to correct shortening and other malformations in patients with ED and complex PD. The study is limited by the small number of patients, the short follow-up period and the performance of the technique by a single high-volume implanter.
The implantation of a penile prosthesis (malleable or inflatable) together with multiple incisions of the plaque/tunica albuginea and grafting with a collagen fleece is a safe and efficient treatment for patients with complex PD in addition to ED and significant shortening. Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece. J Sex Med 2019;16:323-332.
患有阴茎硬结症（PD）和勃起功能障碍（ED）并伴有缩短或其他畸形的患者受益于假体植入和阴茎延长手术。
评估多切口技术联合阴茎假体植入和多个阴茎白膜切开及胶原移植在治疗伴有严重 ED 和阴茎缩短的复杂 PD 病例中的安全性和有效性。
2015 年 2 月至 2018 年 5 月，43 例复杂 PD 患者采用该技术治疗。由一位经验丰富的外科医生（J.I.M.S.）为所有患者进行阴茎假体（可弯曲或可充气 [IPP]）植入，同时进行多个放松白膜切开和用自粘胶原纤维绒片（TachoSil，Baxter Healthcare）移植。
记录阴茎长度和曲率矫正、手术时间和术后并发症的发生率作为观察指标。术前和术后 3 个月、6 个月采用国际勃起功能指数-5 问卷（International Index of Erectile Function-5，IIEF-5）、勃起硬度评分（Erection Hardness Score）、改良勃起功能障碍治疗满意度问卷（modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire）和 PD 问卷（Peyronie's Disease Questionnaire）评估性功能。
中位随访时间为 21 个月（范围 10-31 个月），平均术后阴茎延长 2.5（范围 1-5）cm，PD 问卷的困扰域评分改善 4.4（范围 2-5）分。IPP 和可弯曲阴茎假体手术的平均手术时间分别为 86.7 和 71.6 分钟。未记录到龟头缺血；然而，有 1 例 IPP 感染和 1 例延迟的远端阴茎海绵体侵蚀。23.2%的患者出现血肿或瘀斑。39 例（90.7%）患者完成了改良勃起功能障碍治疗满意度问卷。总体而言，89.7%的患者会推荐这种手术。患者对阴茎伸直度和长度的满意度分别为 94.9%和 82.1%。
描述的技术有助于恢复伴有复杂 PD 的 ED 患者的阴茎长度和勃起功能。
该研究的优势在于为外科医生提供了一种简单、易于应用的技术，用于矫正 ED 和复杂 PD 患者的缩短和其他畸形。该研究的局限性在于患者数量较少，随访时间短，以及由单一高容量植入器进行技术操作。
阴茎假体（可弯曲或可充气）植入联合多个斑块/白膜切开和胶原绒片移植是治疗伴有复杂 PD 且 ED 严重和显著缩短的患者的一种安全有效的治疗方法。Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece. J Sex Med 2019;16:323-332.
