Hammad Muhammed A M, Barham David W, Simhan Jay, Nguyen Tuan, Swerdloff Daniel, Miller Jake, Hatzichristodoulou Georgios, Sempels Maxime, Andrianne Robert, Hotaling James M, Hsieh Tung-Chin, Jones James M, Modgil Vaibhav, Osmonov Daniar, Pearce Ian, Perito Paul, Sadeghi-Nejad Hossein, Suarez-Sarmiento Alfredo, Yafi Faysal A, Gross Martin S
Department of Urology, University of California, Irvine, Orange, CA 92868, United States.
Department of Surgery, Urology Section, Brooke Army Medical Center, San Antonio, TX 78234, United States.
J Sex Med. 2025 Jan 9;22(2):349-355. doi: 10.1093/jsxmed/qdae192.
Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement.
To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort.
A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons. Demographic, intraoperative, and postoperative data were analyzed to assess the improvement in penile curvature following IPP, including adjunctive correction techniques such as manual modeling, tunica albuginea plication, and grafting.
Curvature correction achieved after IPP placement and adjunctive procedures.
For 499 PD patients treated with IPP, median age was 62.0 [30.0, 91.0] years with mean follow-up of 16.5 (SD = 12.9) months. The mean preoperative curvature was 39.4° (SD = 17.8°), with dorsal curvature being most common. Among our cohort, 17.6% had IPP-only placement, while the majority of 82.4% patients underwent IPP along with adjunctive correction procedures. Specifically, manual modeling (with/without the "scratch" technique) was used in 74.7% of cases, tunica albuginea plication in 4.8%, grafting in 2%, and combined grafting and modeling in 0.8%. Patients who underwent grafting generally had fewer preoperative comorbidities and more severe preoperative curvatures of 60.0° [45.0°, 70.0°]. Grafting also provided the highest median curvature correction of 55.0° [48.8°, 73.8°], (P < .001). Plication achieved a median curvature correction of 40.0° [28.8°, 41.2°], whereas modeling resulted in a median curvature reduction of 26.0° [20.0°, 39.5°], (P < .001).
We observed that grafting, though less frequently used, provided more curvature correction in severe PD cases undergoing IPP.
Large cohort size and multinational participation are strengths, though retrospective design and general variability in surgical techniques are limitations.
Adjunctive techniques, including grafting, plication, and modeling provide options for tailoring curvature correction to disease severity and patient characteristics. Future prospective studies are needed to standardize and evaluate the comparative outcomes of these techniques.
对于佩罗尼氏病（PD）和严重勃起功能障碍（ED）患者，建议采用可膨胀阴茎假体（IPP）植入术进行治疗；IPP植入后，可采用辅助手术来矫正残留的阴茎弯曲。
在一个大型跨国多中心队列中，评估接受IPP手术的PD患者阴茎弯曲矫正的治疗情况。
对11位经验丰富的假体外科医生治疗的PD患者进行回顾性分析。分析人口统计学、术中及术后数据，以评估IPP植入术后阴茎弯曲的改善情况，包括手动塑形、白膜折叠和移植等辅助矫正技术。
IPP植入及辅助手术后实现的弯曲矫正。
499例接受IPP治疗的PD患者，中位年龄为62.0岁[30.0, 91.0]，平均随访时间为16.5个月（标准差=12.9）。术前平均弯曲度为39.4°（标准差=17.8°），以背侧弯曲最为常见。在我们的队列中，17.6%的患者仅植入IPP，而82.4%的患者在植入IPP的同时还接受了辅助矫正手术。具体而言，74.7%的病例采用了手动塑形（有/无“刮擦”技术），4.8%采用了白膜折叠，2%采用了移植，0.8%采用了移植与塑形联合。接受移植的患者术前合并症通常较少，术前弯曲度更严重，为60.0°[45.0°, 70.0°]。移植也提供了最高的中位弯曲度矫正，为55.0°[48.8°, 73.8°]，（P<0.001）。折叠实现的中位弯曲度矫正为40.0°[28.8°, 41.2°]，而塑形导致的中位弯曲度降低为26.0°[20.0°, 39.5°]，（P<0.001）。
我们观察到，移植虽然使用频率较低，但在接受IPP治疗的严重PD病例中能提供更多的弯曲度矫正。
队列规模大且有跨国参与是优点，不过回顾性设计和手术技术的普遍差异是局限性。
包括移植、折叠和塑形在内的辅助技术为根据疾病严重程度和患者特征定制弯曲度矫正提供了选择。未来需要进行前瞻性研究，以规范和评估这些技术的比较结果。
