Moisés da Silva Gabriel Veber, Dávila Francisco Javier, Rosito Tiago Elias, Martins Francisco E
Department of Urology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Department of Urology, University of Lisbon, School of Medicine, Centro Hospitalar Universitario Lisboa Norte (CHULN), Lisbon, Portugal.
Front Reprod Health. 2022 Jun 9;4:863844. doi: 10.3389/frph.2022.863844. eCollection 2022.
Peyronie's disease is the disease that results in an alteration in the curvature of the penis, which can lead to a shortening of length, pain in erection, or difficulties in penetration, thus leading the patient to psychological alterations due to loss of functionality such as aesthetic alteration. That is why there are several studies to define the best form of treatment, which currently continues to be the first choice surgical treatment.
We present the most recommended therapies for Peyronie's disease and suggest an algorithm as a guide to direct therapy.
We used the PubMed platform to review the literature related to Peyronie's disease. Various editorials were reviewed as well as original articles and reviews focusing on the various treatments as well as their indications and results.
Peyronie's disease in which conservative or drug treatment does not have a response, surgical treatment with corporoplasty, penile prosthesis implantation or both may be indicated. Corporoplasty refers to both the plication of the tunica albuginea as well as the incision of the tunica with the placement of a graft. An accurate history should always be carried out to identify erectile dysfunction as well as to be able to guide you on the repercussions of the treatment. If refractory erectile dysfunction is present, placement of a penile prosthesis with or without further adjunctive straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and results of the available techniques, and proposed a surgical treatment algorithm.
Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of "borderline" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. An accurate risk/benefit assessment of the individual patient as well as meticulous patient counseling are critically important.
佩罗尼氏病是一种导致阴茎弯曲改变的疾病，可导致阴茎长度缩短、勃起疼痛或性交困难，进而因功能丧失如美观改变而使患者出现心理变化。这就是为什么有多项研究来确定最佳治疗方式，而目前手术治疗仍是首选。
我们介绍佩罗尼氏病最推荐的治疗方法，并提出一种算法作为指导治疗的指南。
我们使用PubMed平台回顾与佩罗尼氏病相关的文献。查阅了各种社论以及专注于各种治疗方法及其适应证和结果的原创文章与综述。
对于保守治疗或药物治疗无效的佩罗尼氏病，可能需要进行白膜成形术、阴茎假体植入术或两者结合的手术治疗。白膜成形术既包括白膜折叠术，也包括切开白膜并植入移植物。应始终进行准确的病史询问，以识别勃起功能障碍，并能够指导了解治疗的影响。如果存在难治性勃起功能障碍，建议植入阴茎假体，可伴有或不伴有进一步的辅助矫直操作。我们回顾了现有技术的适应证、优缺点和结果，并提出了一种手术治疗算法。
阴茎缩短手术通常适用于阴茎长度足够且弯曲度<60°的情况。对于弯曲度>60°、沙漏形或铰链形畸形以及阴茎短小且患者勃起功能良好的情况，可采用部分切除/切开及移植术。存在“临界”勃起功能和/或腹侧弯曲会使选择倾向于缩短手术，而难治性勃起功能障碍则是植入阴茎假体的指征。对个体患者进行准确的风险/收益评估以及细致的患者咨询至关重要。
