madman
Super Moderator
ABSTRACT
Background/aim: We aimed to evaluate the effectiveness and safety of penile plaque incision and buccal mucosa grafting in patients with stable-phase Peyronie’s disease (PD).
Methods: This was a prospective evaluation of patients with stable-phase PD who were treated by plaque incision and buccal mucosa grafting. Preoperative evaluation included the International Index of Erectile Function Questionnaire (IIEF-5), measurement of erect penile length, and penile Doppler ultrasound during prostaglandin-induced erection. At 3- and 24-month follow-up visits, penile length, and residual curvature were measured along with penile Doppler ultrasound and IIEF5 questionnaires. Patient and sexual partner satisfaction was also assessed at 24-month-visit.
Results: The study was completed with 20 patients (mean age 46.5 ± 9.9 years). Dorsal curvature was the most frequent site of curvature (45%). The median curvature at preoperative evaluation was 45°(range 40-90°). The postoperative median curvatures were 5°(5-10, IQR) and 7°(5-10, IQR) at 3- and 24-month postoperatively, respectively. The success rate was 95% at 3-month and 90% at 24-month. There was no significant penile shortening. The mean IIEF-5 score was 17.5 ± 2.2 at preoperative evaluation. The median IIEF-5 scores were calculated as 20.1 ± 2.2 and 21.3 ± 2.2 at 3-month and 24-month visits, respectively (p<0.0001). Compared with baseline IIEF-5 scores, both postoperative IIEF-5 scores were significantly higher. There was no de novo erectile dysfunction. There were no serious complications during and after the surgery. Ten percent of patients were poorly satisfied with the results of the surgery.
Conclusion: Corporoplasty with buccal mucosa graft led to excellent structural and functional results and patient satisfaction.
INTRODUCTION
Peyronie disease (PD) is defined as an organic disorder characterized by penile deformities and pain, commonly accompanied by a palpable plaque.1 Penile deformity involves curvature, shortening, and hourglass deformity. A recent population-based study in Australia revealed that 19% of the surveyed men had a penile curvature.2 Several studies reported the prevalence of PD ranging between 0.4 and 20%, 3-5.
Though it is thought that PD results mainly from repetitive trauma to the erect penis, the pathophysiology seems multifactorial. These repetitive traumas during intercourse lead to microbleeds with subsequent inflammation and fibrous plaque development, for which transforming growth factor-beta plays a prominent role.6 Two stages are distinguished during the course of PD; the active phase usually lasts less than 6 months and is characterized by pain and changing penile curvature. The stable phase develops 6-12 months after the disease onset and is recognized by palpable plaque and penile deformity in the absence of pain. Although PD is a progressive disorder, in a minority of patients, spontaneous resolution may be seen.7
Although none is curative, several medical and surgical treatment options exist for PD. Despite significant improvements in medical and conservative treatment modalities, surgical reconstruction still remains the gold standard of chronic stable phase PD.8 Currently, the most popular surgical technique is plaque incision and grafting. Several graft materials have been tried to be able to attain the best functional result with the lowest complication rate.9
DISCUSSION
The most notable findings of the present study were as follows: First, plaque incision and buccal mucosa grafting was an effective and safe penile reconstruction procedure in patients with PD. The success rate was 95% at 3 months and 90% at 24 months without a major adverse event. Second, the rate of de novo erectile dysfunction was zero. In contrast, most of the patients with lower IIEF-scores (patients with mild and mild-to-moderate erectile dysfunction) improved after the surgery. All patients except two and all of their sexual partners were satisfied with the results attained by the surgery. Third, none of the patients who underwent the surgery experienced loss of penile length. On the contrary, 70% of patients had increased penile length at the 24 months visit relative to their baseline values with a mean 12.6 mm literal increase in length in the whole group. Our results, in general, confirmed the findings of the previous studies that utilized buccal mucosa in the repair of the penile curvature reconstruction.
*As far as we know, we reported for the first time Doppler changes in the reconstructed penis in buccal mucosa grafting. Peak systolic velocity and end-diastolic velocity showed significant changes relative to preoperative values, whereas the resistance index was stable throughout the follow-up period. And we think that favorable results in terms of erectile function in part results from this positive change in penile vasculature.
In conclusion, despite its aforementioned limitations, our study contributes to the current state of knowledge regarding the safety and efficacy of buccal mucosa grafting in PD. Our study confirmed the results of the previous studies and showed that corporoplasty with buccal mucosa led to excellent structural, functional, and patient satisfaction results. At 24 months, we demonstrated that the vast majority of PD patients were afforded to maintain their lives with a straight, sufficiently rigid, and satisfying penis. We think, based on our and previous studies’ results, that plaque incision and buccal mucosa grafting seem like an effective and safe correction procedure in patients with Peyronie’s disease, which is worthy of further research. The success of this surgical approach in terms of ED should be further evaluated with dedicated questionnaires validated for use in patients with PD.
Background/aim: We aimed to evaluate the effectiveness and safety of penile plaque incision and buccal mucosa grafting in patients with stable-phase Peyronie’s disease (PD).
Methods: This was a prospective evaluation of patients with stable-phase PD who were treated by plaque incision and buccal mucosa grafting. Preoperative evaluation included the International Index of Erectile Function Questionnaire (IIEF-5), measurement of erect penile length, and penile Doppler ultrasound during prostaglandin-induced erection. At 3- and 24-month follow-up visits, penile length, and residual curvature were measured along with penile Doppler ultrasound and IIEF5 questionnaires. Patient and sexual partner satisfaction was also assessed at 24-month-visit.
Results: The study was completed with 20 patients (mean age 46.5 ± 9.9 years). Dorsal curvature was the most frequent site of curvature (45%). The median curvature at preoperative evaluation was 45°(range 40-90°). The postoperative median curvatures were 5°(5-10, IQR) and 7°(5-10, IQR) at 3- and 24-month postoperatively, respectively. The success rate was 95% at 3-month and 90% at 24-month. There was no significant penile shortening. The mean IIEF-5 score was 17.5 ± 2.2 at preoperative evaluation. The median IIEF-5 scores were calculated as 20.1 ± 2.2 and 21.3 ± 2.2 at 3-month and 24-month visits, respectively (p<0.0001). Compared with baseline IIEF-5 scores, both postoperative IIEF-5 scores were significantly higher. There was no de novo erectile dysfunction. There were no serious complications during and after the surgery. Ten percent of patients were poorly satisfied with the results of the surgery.
Conclusion: Corporoplasty with buccal mucosa graft led to excellent structural and functional results and patient satisfaction.
INTRODUCTION
Peyronie disease (PD) is defined as an organic disorder characterized by penile deformities and pain, commonly accompanied by a palpable plaque.1 Penile deformity involves curvature, shortening, and hourglass deformity. A recent population-based study in Australia revealed that 19% of the surveyed men had a penile curvature.2 Several studies reported the prevalence of PD ranging between 0.4 and 20%, 3-5.
Though it is thought that PD results mainly from repetitive trauma to the erect penis, the pathophysiology seems multifactorial. These repetitive traumas during intercourse lead to microbleeds with subsequent inflammation and fibrous plaque development, for which transforming growth factor-beta plays a prominent role.6 Two stages are distinguished during the course of PD; the active phase usually lasts less than 6 months and is characterized by pain and changing penile curvature. The stable phase develops 6-12 months after the disease onset and is recognized by palpable plaque and penile deformity in the absence of pain. Although PD is a progressive disorder, in a minority of patients, spontaneous resolution may be seen.7
Although none is curative, several medical and surgical treatment options exist for PD. Despite significant improvements in medical and conservative treatment modalities, surgical reconstruction still remains the gold standard of chronic stable phase PD.8 Currently, the most popular surgical technique is plaque incision and grafting. Several graft materials have been tried to be able to attain the best functional result with the lowest complication rate.9
DISCUSSION
The most notable findings of the present study were as follows: First, plaque incision and buccal mucosa grafting was an effective and safe penile reconstruction procedure in patients with PD. The success rate was 95% at 3 months and 90% at 24 months without a major adverse event. Second, the rate of de novo erectile dysfunction was zero. In contrast, most of the patients with lower IIEF-scores (patients with mild and mild-to-moderate erectile dysfunction) improved after the surgery. All patients except two and all of their sexual partners were satisfied with the results attained by the surgery. Third, none of the patients who underwent the surgery experienced loss of penile length. On the contrary, 70% of patients had increased penile length at the 24 months visit relative to their baseline values with a mean 12.6 mm literal increase in length in the whole group. Our results, in general, confirmed the findings of the previous studies that utilized buccal mucosa in the repair of the penile curvature reconstruction.
*As far as we know, we reported for the first time Doppler changes in the reconstructed penis in buccal mucosa grafting. Peak systolic velocity and end-diastolic velocity showed significant changes relative to preoperative values, whereas the resistance index was stable throughout the follow-up period. And we think that favorable results in terms of erectile function in part results from this positive change in penile vasculature.
In conclusion, despite its aforementioned limitations, our study contributes to the current state of knowledge regarding the safety and efficacy of buccal mucosa grafting in PD. Our study confirmed the results of the previous studies and showed that corporoplasty with buccal mucosa led to excellent structural, functional, and patient satisfaction results. At 24 months, we demonstrated that the vast majority of PD patients were afforded to maintain their lives with a straight, sufficiently rigid, and satisfying penis. We think, based on our and previous studies’ results, that plaque incision and buccal mucosa grafting seem like an effective and safe correction procedure in patients with Peyronie’s disease, which is worthy of further research. The success of this surgical approach in terms of ED should be further evaluated with dedicated questionnaires validated for use in patients with PD.
