Levine L A, Lenting E L
Department of Urology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.
J Urol. 1997 Dec;158(6):2149-52. doi: 10.1016/s0022-5347(01)68184-9.
When conservative treatment of Peyronie's disease fails, the optimal surgical approach is not well defined. Multiple factors, including penile rigidity, degree of curvature, shaft narrowing with hinge effect and erectile response to vasoactive penile injections, indicate that no single approach is likely to solve the problem in all patients.
A surgical algorithm was developed for the treatment of Peyronie's Disease based on our previous surgical experience, which was used prospectively in 103 consecutive men. Penile straightening without prosthesis was offered to patients with adequate rigidity for coitus. Specifically, for mild to moderate curvature less than 60 degrees without hourglass or hinge effect deformity the less complicated tunica albuginea plication procedure was performed. For those men with more severe, complex curvature greater than 60 degrees and/or significant hourglass or hinge effect deformity plaque incision or partial excision with dermal grafting was offered to limit shaft shortening and to reconstruct a shaft with normal caliber to provide optimal axial support during intromission. For men with poor sexually induced erections and/or inadequate response to intracavernosal pharmacotherapy penile prosthesis placement was recommended to provide adequate straightening and rigidity.
Of 22 patients who underwent plication procedures 91% remained potent and the penis remained straight postoperatively. Of 52 patients who underwent an incision or partial excision and grafting procedure, 48 had dermal grafts with the penis remaining straight in 94% and 75% remaining potent postoperatively. A total of 29 patients received a prosthesis with the penis remaining straight in 93% who were sexually active postoperatively. During the follow up period (mean 22.3 months) there have been no mechanical device failures.
Surgical outcome was optimized with this algorithm, which correlates surgical complexity to the underlying severity of the penile deformity and erectile capacity.
当佩罗尼氏病的保守治疗失败时，最佳手术方法尚无明确定义。包括阴茎硬度、弯曲程度、伴有铰链效应的阴茎干变窄以及对血管活性阴茎注射的勃起反应等多种因素表明，没有单一方法可能解决所有患者的问题。
基于我们之前的手术经验，开发了一种用于治疗佩罗尼氏病的手术算法，并前瞻性地应用于103例连续的男性患者。对于具有足够性交硬度的患者，提供无假体的阴茎矫直术。具体而言，对于小于60度的轻度至中度弯曲且无沙漏样或铰链效应畸形的患者，进行较简单的白膜折叠术。对于那些弯曲更严重、复杂程度大于60度和/或有明显沙漏样或铰链效应畸形的男性，提供斑块切开或部分切除并植皮，以限制阴茎干缩短，并重建具有正常管径的阴茎干，以便在插入时提供最佳轴向支撑。对于性诱导勃起不佳和/或对海绵体内药物治疗反应不足的男性，建议植入阴茎假体以提供足够的矫直和硬度。
在接受折叠术的22例患者中，91%术后仍保持勃起功能，阴茎保持伸直。在接受切开或部分切除及植皮手术的52例患者中，48例进行了植皮，术后94%的患者阴茎保持伸直，75%的患者仍保持勃起功能。共有29例患者接受了假体植入，术后93%的患者阴茎保持伸直且有性活动。在随访期（平均22.3个月）内，没有机械装置故障。
该算法优化了手术结果，它将手术复杂性与阴茎畸形和勃起能力的潜在严重程度相关联。
