Sokolakis Ioannis, Pyrgidis Nikolaos, Mykoniatis Ioannis, Dimitriadis Fotios, Hatzichristodoulou Georgios
Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
1st Department of Urology, Aristotle University of Thessaloniki, Gennimatas Hospital, Thessaloniki, Greece.
Transl Androl Urol. 2021 Jun;10(6):2669-2681. doi: 10.21037/tau-20-1236.
Residual curvature correction during penile prosthesis implantation (PPI) is usually needed in patients with severe erectile dysfunction (ED) and concomitant Peyronie's disease (PD). The aim of the study was to assess the different existing techniques for treating residual penile curvature during PPI in patients with severe PD and ED. We generated a comprehensive narrative review of the literature until August 2020 on the use of PPI in combination with straightening reconstruction techniques, in treating patients with severe PD and ED. We included studies published in English, assessing the PPI as primary intervention in patients with PD and ED. Secondary research studies and studies with insufficient data were excluded from final analyses. We included a total of 33 clinical articles with 1,612 patients that assessed the effects of PPI combined with straightening surgical techniques for the treatment of severe PD and ED. Based on the severity of penile curvature, the concomitance of additional penile deformities (i.e., hourglass deformity), the penile length, the presence of previous penile operations and the surgeon's experience, four main categories of surgical techniques were identified: (I) PPI with plication of the penis on the convex side of the curvature, (II) transcorporeal plaque incision/excision, (III) PPI with plaque/tunical incision(s) on the concave side of the curvature and (IV) PPI with plaque incision/excision plus grafting. Patients with severe PD and ED can expect excellent outcomes with PPI and surgical correction of residual penile curvature and minimal side effects. Overall, all the above techniques seem to able to correct the residual penile curvature during prosthesis implantation. Grafting techniques seem to be favorable in patients with additional severe penile shortening. Still, no definite conclusions can be drawn regarding the superiority of one technique over the other.
重度勃起功能障碍（ED）合并佩罗尼氏病（PD）的患者在阴茎假体植入（PPI）过程中通常需要进行残余曲率矫正。本研究的目的是评估在重度PD和ED患者的PPI过程中治疗残余阴茎曲率的不同现有技术。我们对截至2020年8月的文献进行了全面的叙述性综述，内容涉及PPI结合矫直重建技术治疗重度PD和ED患者的情况。我们纳入了以英文发表的研究，评估PPI作为PD和ED患者的主要干预措施。二次研究和数据不足的研究被排除在最终分析之外。我们总共纳入了33篇临床文章，涉及1612例患者，这些文章评估了PPI结合矫直手术技术治疗重度PD和ED的效果。根据阴茎曲率的严重程度、是否合并其他阴茎畸形（如沙漏畸形）、阴茎长度、既往阴茎手术史以及外科医生的经验，确定了四类主要手术技术：（I）在曲率凸侧进行阴茎折叠的PPI，（II）经体部斑块切开/切除，（III）在曲率凹侧进行斑块/白膜切开的PPI，以及（IV）斑块切开/切除加移植的PPI。重度PD和ED患者通过PPI以及残余阴茎曲率的手术矫正有望获得良好的效果，且副作用最小。总体而言，上述所有技术似乎都能够在假体植入过程中矫正残余阴茎曲率。移植技术似乎对合并严重阴茎缩短的患者有利。不过，关于一种技术相对于另一种技术的优越性尚无明确结论。
