Comparison of long-term patient reported outcomes of excisional and incisional corporoplasties for Peyronie's disease.

BACKGROUND

To compare surgical and long-term patient-reported outcomes (PRO) between excisional (Nesbit) and incisional (Yachia) corporoplasty for correction of uncomplicated Peyronie's-related penile curvature in a large, single-surgeon cohort. A retrospective audit identified men who underwent Nesbit or Yachia corporoplasty (2015-2021). Operative data was extracted from records. A structured telephone survey captured long-term PRO.

RESULTS

The cohort comprised 101 men (Nesbit = 31, Yachia = 70). Nesbit patients were younger (55 vs 59.7 yr; p = 0.02) and had greater baseline curvature (55° vs 45°; p = 0.01). Every case was surgically successful (residual curvature < 20° in 100%, < 10° in 58% overall, p = 0.66). Yachia procedures were shorter (45 vs 71 min; p < 0.05) but required > 2 plications more often (41% vs 7%; p = 0.01). The PRO survey had a 74.3% response rate, with a median follow-up of 5 years. 'Patient Global Impression of Improvement' scores reflected strong improvement with median scores of 1 ("very much better") and 2 ("much better") in the Nesbit and Yachia groups respectively (p = 0.35). However, this perceived improvement did not translate uniformly into long-term satisfaction. Only 66.7% of respondents reported being "completely" or "mostly" satisfied with the overall outcome (p = 0.60). The most frequent cause of dissatisfaction was perceived penile shortening, reported by 85% of men. Erectile function declined postoperatively in 30% of Yachia and 15% of Nesbit patients (p = 0.03), though this is possibly confounded by the older age of the Yachia cohort. Bothersome curvature recurrence and post-operative cosmesis did not significantly impact satisfaction in either group.

CONCLUSIONS

Both Nesbit and Yachia corporoplasties provide effective and durable results with comparable long-term patient satisfaction. Regardless of technique, subjective reporting of penile shortening was particularly pervasive and was highly bothersome. This underscores the need for meticulous pre-operative counselling.