Peyronie's disease: surgical treatment based on penile rigidity.

Operative treatment of Peyronie's disease has the risk of penile shortening and/or loss of erection. To avoid these complications, we used plaque incision together with polytetrafluoroethylene (Gore-Tex) graft insertion in men with preserved penile rigidity and only implanted a penile prosthesis in men with erectile failure. Between August 1986 and July 1992, 24 men 36 to 72 years old (mean age 53 years) underwent surgery. Of the men 16 with adequate penile rigidity by history and/or RigiScan study, and severe curvature underwent plaque incision and polytetrafluoroethylene graft insertion. Eight men had erectile failure, including 4 with distal flaccidity as demonstrated by RigiScan study. These 8 men received a penile prosthesis (semirigid in 6 and inflatable in 2). In addition, 2 of these men also required plaque incision because of persistent curvature. With a mean followup of 47 months (range 20 to 92), all 16 men with incision and a polytetrafluoroethylene graft had excellent erections with satisfactory intercourse. Minimal curvature away from the plaque incision site, not causing any difficulty with sexual performance, occurred in 7 patients. The men with a penile prosthesis engage in normal intercourse without residual or recurrent curvature. Incision of Peyronie's plaque and polytetrafluoroethylene graft insertion is associated with an excellent functional result in men with normal preoperative penile rigidity. A penile prosthesis should be reserved for men with erectile failure.