Cordon Billy H, Sundaram Varun, Hofer Matthias D, Kavoussi Nicholas L, Scott Jeremy M, Morey Allen F
Department of Urology, University of Texas Southwestern, Dallas, Texas.
Urol Pract. 2017 Mar;4(2):149-154. doi: 10.1016/j.urpr.2016.05.003. Epub 2016 Oct 6.
We identified clinical and/or surgical factors contributing to failure of penile plication for Peyronie's reconstruction and assessed outcomes of repeat plications.
We conducted a retrospective review of patients who underwent penile plication between 2007 and 2016. Plication was performed after inducing an artificial erection intraoperatively using corrective longitudinal 2-zero Ethibond™ sutures placed systematically in a uniform manner without circumcision. Penile length, and angle and direction of curvature were recorded, along with number and location of plication sutures and clinical outcome.
Of 340 patients undergoing penile plication during the study period 7 (2.1%) underwent repeat plication for insufficient straightening. Two additional patients underwent salvage plication after initial surgery performed elsewhere. Median time to revision was 6 months (range 3.4 to 27.4). The most common clinical features at reoperation were severe erectile dysfunction in 5 cases (71%), multiplanar curvature in 5 (71%) and severe curvature (60 degrees or greater) in 3 (43%). Most revisions involved a greater number of sutures during revision (mean 9) compared to initial plication (6), and in 4 cases (44%) sutures were placed on the proximal shaft. After revision all cases were noted to be functionally straight, with a mean postoperative curvature of 4 degrees (range 0 to 20) at a median followup of 27 months (3 to 76).
Inadequate correction of Peyronie's disease curvature by penile plication is rare but salvageable by a second plication procedure. Poor erectile response to intracavernous injection intraoperatively may mask the severity of the deformity, thus leading to inadequate numbers of corrective sutures.
我们确定了导致佩罗尼氏病重建阴茎折叠术失败的临床和/或手术因素，并评估了重复折叠术的结果。
我们对2007年至2016年间接受阴茎折叠术的患者进行了回顾性研究。术中使用矫正纵向2-0 Ethibond™缝线以统一方式系统地放置，在不进行包皮环切的情况下诱导人工勃起后进行折叠术。记录阴茎长度、弯曲角度和方向，以及折叠缝线的数量和位置和临床结果。
在研究期间接受阴茎折叠术的340例患者中，7例（2.1%）因矫正不足而接受了重复折叠术。另外2例患者在其他地方进行初次手术后接受了挽救性折叠术。翻修的中位时间为6个月（范围3.4至27.4个月）。再次手术时最常见的临床特征是5例（71%）严重勃起功能障碍，5例（71%）多平面弯曲，3例（43%）严重弯曲（60度或更大）。与初次折叠术（平均6针）相比，大多数翻修术在翻修时使用了更多的缝线（平均9针），4例（44%）在近端阴茎体放置了缝线。翻修术后所有病例在功能上均变直，中位随访27个月（3至76个月）时平均术后弯曲度为4度（范围0至20度）。
阴茎折叠术对佩罗尼氏病弯曲矫正不足的情况很少见，但可通过二次折叠手术挽救。术中对海绵体内注射勃起反应不佳可能掩盖畸形的严重程度，从而导致矫正缝线数量不足。
