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2.
Urologiia ; (3): 124-127, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356025

RESUMO

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.


Assuntos
Disfunção Erétil , Implante Peniano , Induração Peniana , Implantação de Prótese , Humanos , Masculino , Induração Peniana/cirurgia , Pênis
3.
Curr Urol Rep ; 20(8): 42, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31201571

RESUMO

PURPOSE OF REVIEW: To explore the potential hurdles surgeons may encounter when preforming surgical correction of penile curvature in patients with Peyronie's Disease following intralesional collagenase clostridium histolyticum injections. RECENT FINDINGS: Although limited data exists, retrospective analysis of surgeon experiences in surgical treatment of refractory penile curvature in patients with Peyronie's disease appears to not result in more post-operative complications and may only slightly increase intra-operative difficulty. As the use of intralesional collagenase clostridium histolyticum continues to increase and patients who demonstrate persistent curvature despite treatment seek further management, the role of investigating the feasibility of surgery demonstrates significant importance. Although limited data exists, it appears that surgery following intralesional collagenase clostridium histolyticum is safe without added post-operative complications. At the present time, however, further data on intra-operative findings and post-operative outcomes remain necessary, and as the use of this intralesional therapy continues to rise, further information should become readily available.


Assuntos
Anti-Inflamatórios/administração & dosagem , Colagenase Microbiana/administração & dosagem , Induração Peniana/tratamento farmacológico , Induração Peniana/cirurgia , Pênis/efeitos dos fármacos , Pênis/cirurgia , Estudos de Viabilidade , Humanos , Injeções Intralesionais , Masculino , Induração Peniana/etiologia , Resultado do Tratamento
4.
Arch Esp Urol ; 72(4): 415-421, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31070138

RESUMO

OBJECTIVES: To evaluate long-term outcomes of patients subjected to corporoplasty, plaque incision and excision, and autologous dermal grafting, with at least 15 years of follow-up. METHODS: The charts of consecutive patients with a penile curvature and a minimum of 15 years follow up were retrospectively reviewed. The patients underwent corporoplasty and penile straightening with autologous dermal grafting, harvested at the level of the anterior-superior iliac spine. At the time of the follow-up, a postoperative IIEF - 5 questionnaire was administered by telephonic interview, and patients were also asked to complete an 8 items self-evaluation questionnaire. After signing informed consent, the patients were invited to undergo dynamic and basal penile sonography, as well as injection of 10 mcg of PGE1 for dynamic evaluation of the graft. RESULTS: A total of 16 patients were identified. Penile shortening of up to 1.5 cm was reported in about 40% of cases and residual bending was reported by 4 of 16 patients. However, there was no impairment in penetration. On physical examination of the suture site, a small indurated nodule was palpable in two patients. Data regarding the dynamic sonography is available for the 5 patients who accepted to undergo the test. No sign of a fibrotic reaction or calcification was detected in the static phase. After injection of 10 mcg PGE-1, in comparison to the basal measurement, the dermal grafts showed compliant length adaptation. CONCLUSIONS: Dermal graft substitution surgery for Peyronie's disease allows to obtain good functional results with durable satisfaction of the patients on long term follow up.


Assuntos
Induração Peniana , Transplante de Pele , Seguimentos , Humanos , Masculino , Induração Peniana/cirurgia , Pênis/cirurgia , Estudos Retrospectivos
5.
Urology ; 129: 106-112, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30954611

RESUMO

OBJECTIVE: To compare the patient's satisfaction and long-term results of 2 penile plication procedures in patients with penile curvature. METHODS: This retrospective study included 387 patients with congenital penile curvature (n = 260) and Peyronie's disease (n = 127) who underwent surgical correction of penile curvature with penile plication procedures. Of the patients, 202 underwent plication of tunica albuginea with the Lue's 16-dot technique, while 185 underwent highly superficial excision of tunica albuginea with the modified Nesbit corporoplasty. Surgical outcomes and patient's satisfaction were compared between the 2 techniques in all patients. RESULTS: The mean duration of surgery was significantly shorter in the 16-dot plication technique (48.1 ±â€¯7.5 minutes), compared with the modified Nesbit corporoplasty (63 ±â€¯16.9 minutes) (P = .001). Complete penile straightening was achieved in 87.6% of the patients who underwent 16-dot plication technique and in 89.7% of the patients who underwent modified Nesbit plication, revealing no difference (P = .514). The rates of penile sensory loss (P = .001) and de-novo erectile dysfunction (P = .016) were significantly higher in the modified Nesbit corporoplasty than in the 16-dot plication technique, but rate of suture related complications was significantly higher in the 16-dot plication technique than in the modified Nesbit corporoplasty (P = .001). The patients with congenital penile curvature had significantly less ratio of postoperative penile length loss and de-novo erectile dysfunction than Peyronie's disease patients. CONCLUSION: Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the 2 surgical procedures. Therefore, patients with penile curvature should be informed about outcomes of penile plication procedures, and surgical method should be preferred based on patient's preference and surgeon's experience.


Assuntos
Satisfação do Paciente , Ereção Peniana/fisiologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Técnicas de Sutura , Suturas , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/diagnóstico , Induração Peniana/fisiopatologia , Induração Peniana/cirurgia , Pênis/diagnóstico por imagem , Pênis/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Ultrassonografia Doppler , Adulto Jovem
6.
Curr Urol Rep ; 20(4): 17, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30847729

RESUMO

PURPOSE OF REVIEW: The inflatable penile prosthesis (IPP) was introduced in 1973. Since that time, the fundamental design of the IPP has not changed, but numerous improvements to the device, surgery, and peri-operative management have resulted in a modern IPP with excellent reliability, infection control, safety profile, and user experience. RECENT FINDINGS: We describe important modifications to the IPP and review available data assessing the impact of these changes. We also discuss possible changes to the IPP that would result in continued improvement. Since its introduction in 1973, changes to the penile prosthesis have resulted in significant improvements in reliability, infection control, safety, and user experience. Design changes are anticipated to continue, resulting in a better and more versatile penile prosthesis.


Assuntos
Disfunção Erétil/cirurgia , Induração Peniana/cirurgia , Prótese de Pênis , Desenho de Prótese , Implantação de Prótese/instrumentação , Humanos , Masculino , Induração Peniana/complicações , Reprodutibilidade dos Testes
7.
Curr Urol Rep ; 20(2): 9, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30701338

RESUMO

PURPOSE OF REVIEW: The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches. RECENT FINDINGS: Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. The goal of these operations is not only to correct curvature, but also to restore length. Not surprisingly, the more complex and aggressive the attempt to correct the curvature, the more complications are possible. While modeling has a low rate of urethral injury, complex lengthening procedure with neurovascular bundle and urethral mobilization may lead to the dreaded complication of glans necrosis. Meanwhile, transcorporal techniques seem to offer a more modest improvement for length and curvature restoration with fewer risks than those seen in more aggressive lengthening procedures. The main limitation to the historical treatment of Peyronie's disease during penile prosthesis, modeling, and plaque incision is there is often no resolution to the penile length-as the maneuvers are made after the implant is already in place. Newer lengthening procedures are promising, however carry increased risks and complexity.


Assuntos
Implante Peniano/métodos , Induração Peniana/cirurgia , Prótese de Pênis , Pênis/cirurgia , Dissecação , História do Século XX , História do Século XXI , Humanos , Masculino , Implante Peniano/efeitos adversos , Implante Peniano/história , Induração Peniana/história , Prótese de Pênis/efeitos adversos , Prótese de Pênis/história , Pênis/patologia
8.
Urology ; 126: 204-208, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30677456

RESUMO

OBJECTIVE: To assess functional outcomes after surgical correction of congenital and acquired penile curvatures using Yachia's technique (YT) with degloving (DG) and without degloving (WDG) of the penis. MATERIALS AND METHODS: A penile deformity with angle ≥30°, difficulty in vaginal penetration, and severity of erectile dysfunction secondary to penile curvatures were the indications for a surgical treatment with YT. The preoperative characteristics of the patients, postoperative outcomes (change in angulation, palpation of sutures, penile shortening, and patient satisfaction), operative time, and hospital stay were recorded. A total of 64 patients were included in this review and divided into 2 groups: 34 in group I (YT with DG) and 30 in group II (YT-WDG). RESULTS: The mean operative time was 65.87 ± 21.32 minutes for group I and 48.17 ± 23.82 minutes for group II (P < .02). The mean hospital stay was 3.09 ± 0.96 and 2.87 ± 0.93 days in DG and WDG, respectively (P = .324). There were no significant differences in recurrence rates and complications (palpation of sutures: group I: 14.7% vs. group II: 13.3%; penile shortening: group I: 8.9% vs. group II: 10%). At follow-up of 20.8 months, all treated patients were able to insert the penis in the partner's vagina, were satisfied overall with sexual intercourse. CONCLUSION: The outcomes of the DG and WDG techniques were similar, even if the YT-WDG presents better results in terms of less healing and operative time.


Assuntos
Induração Peniana/cirurgia , Pênis/anormalidades , Pênis/cirurgia , Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
9.
Nat Rev Urol ; 16(2): 79-97, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30367131

RESUMO

Fibrosis is often caused by chronic tissue injury leading to a persisting inflammatory response with excessive accumulation of extracellular connective tissue proteins. Peyronie's disease, urethral stricture and penile (corpora cavernosa) fibrosis are localized fibrotic disorders of the penile connective tissues that can substantially impair a patient's quality of life. Research over the past few decades has revealed the ability of stem cells to secrete a wide range of paracrine factors, a characteristic that could be exploited therapeutically to prevent and treat several inflammatory and fibrotic diseases. In preclinical studies, mesenchymal stem cells (MSCs) have proven to be the most effective and readily available type of stem cells for therapeutic use. An important advantage of MSCs is their ability to circumvent the immune system and function as immunomodulatory 'drug stores' to influence multiple cell types simultaneously. Many studies using stem cells have been applied exclusively to corpora cavernosa fibrosis owing to its well-established disease models. A plethora of preclinical data suggest the benefit of stem cells for use in penile fibrosis. However, their exact mechanism of action and optimal timing and mode of administration must be determined before clinical translation.


Assuntos
Induração Peniana/cirurgia , Pênis/patologia , Pênis/cirurgia , Transplante de Células-Tronco , Estreitamento Uretral/cirurgia , Fibrose/cirurgia , Humanos , Masculino , Células-Tronco Mesenquimais/citologia
10.
Sex Med Rev ; 7(1): 156-166, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30301708

RESUMO

INTRODUCTION: Peyronie's disease (PD) is associated with penile length loss due to atrophy that occurs as a result of fibrous inelastic scarring. Studies have shown diminished penile length and girth, as well as the inability to participate in sexual activity, can lead to decreased quality of life, emotional challenges, and sexual dissatisfaction in a large percentage of men. AIM: To provide a summary of the new developments in the surgical techniques available for the PD patient, with a focus on procedures that provide penile size restoration. METHODS: A MEDLINE PubMed search was used to identify articles related to surgical treatments for PD, including plication procedures, penile prosthesis placement, and techniques for size restoration. MAIN OUTCOME MEASURE: Types of surgical treatments for PD and their outcomes regarding penile length and patient satisfaction. RESULTS: The Nesbit procedure, among other plication procedures, and penile prosthesis placement with modeling or plication are likely to decrease penile length. Although plaque incision with grafting offers restoration of penile length, it carries a risk of postoperative erectile dysfunction (ED). For men with concomitant ED and severe curvature not amenable to prosthesis with modeling or plication, options include grafting, circumferential tunical incisions, subcoronal prosthesis placement, and the sliding technique with its modifications, allowing for management of both PD and ED while restoring penile length. Adjunct procedures, such as ventral phalloplasty and suspensory ligament release, have also been shown to restore length in PD patients. Novel therapies continue to evolve with the goal of preserving length while treating curvature. CONCLUSION: There are numerous surgical options for correcting penile curvature in PD patients, with or without concomitant ED treatment. When determining the optimal procedure, it is important to consider possible preservation of penile length and to discuss possible complications to increase patient satisfaction and improve quality of life. Barrett-Harlow B, Clavell-Hernandez J, Wang R. New Developments in Surgical Treatment for Penile Size Preservation in Peyronie's Disease. Sex Med Rev 2019;7:156-166.


Assuntos
Tamanho do Órgão/fisiologia , Satisfação do Paciente/estatística & dados numéricos , Ereção Peniana/fisiologia , Induração Peniana/cirurgia , Pênis/fisiologia , Humanos , Masculino , Ereção Peniana/psicologia , Induração Peniana/fisiopatologia , Induração Peniana/psicologia , Prótese de Pênis , Pênis/anatomia & histologia , Pênis/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Resultado do Tratamento
11.
Andrologia ; 51(1): e13168, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30298592

RESUMO

The aim of this study was to evaluate acellular porcine pericardium (APP) and compared the results with those obtained from venous grafts in the surgical management of Peyronie's disease (PD). An APP (Group 1) and an autologous saphenous vein graft (Group 2) were used in 27 and 26 patients, respectively for Peyronie's correction. The patients' age, body mass index (BMI), operation time, duration of follow-up, preoperative and postoperative IIEF-5 scores, plaque size and loss of sensation were evaluated in both groups. There were no differences between the two groups in terms of age, BMI, follow-up period, and preoperative and postoperative IIEF-5 scores. The postoperative IIEF-5 scores were higher than the preoperative IIEF-5 scores in both groups. The operation time was significantly longer in Group 2 than in Group 1. The duration of sensation loss was shorter in Group 1 compared to Group 2. Penile shortening was similar in both groups.


Assuntos
Induração Peniana/cirurgia , Veia Safena/cirurgia , Enxerto Vascular/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
14.
J Sex Med ; 15(10): 1498-1505, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30228083

RESUMO

INTRODUCTION: Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. AIM: To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. METHODS: We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. MAIN OUTCOME MEASURE: Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. RESULTS: Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3-84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P < .001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P < .001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P = .84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P > .1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P = .9) and post-operatively (19.4 vs 17.6, respectively, P = .15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P = .01) and pre-operative IIEF (odds ratio 1.14, P = .02). CLINICAL IMPLICATIONS: PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. STRENGTH & LIMITATIONS: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. CONCLUSION: Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498-1505.


Assuntos
Induração Peniana/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Induração Peniana/fisiopatologia , Pênis/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
15.
J Sex Med ; 15(10): 1491-1497, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30195564

RESUMO

INTRODUCTION: Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes. AIM: To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such. METHODS: The study population consisted of patients with PD-associated penile curvature who underwent PIG surgery with at least 6 months of follow-up. Demographics and PD factors were recorded. Patient had preoperative assessment of penile sensation and deformity. Postoperative follow-up occurred at 1 week, 1 month, 6 months, and 1 year after surgery. Neurovascular bundle elevation was conducted with loupe magnification. MAIN OUTCOME MEASURE: Penile sensation was evaluated with a biothesiometer and graded on a patient-reported visual analog scale (0-10) in which 0 defined a completely numb area and 10 defined perfect sensation. The degree of sensation loss was defined as extensive (any 1 area >5 cm), major (2-5 cm), and minor (≤2 cm). The penile sensation loss distribution was defined as focal (1 site) or diffuse (>1 site). RESULTS: 63 patients were analyzed. Mean age was 56 ± 10 years. Mean duration of PD at the time of PIG was 15 ± 7 (12-38) months. 75% had curvature alone, and 25% had hourglass/indentation deformities. Mean primary curvature was 64˚ ± 28˚. The mean operation duration was 3.5 ± 1.8 hours. 21% had some degree of sensation loss at 1 week, 21% at 1 month, 8% at 6 months, and 3% at 12 months. Only 1 patient (1.5%) at 2 years continued to have extensive sensation loss on the glans and distal shaft with a very elevated sensitivity threshold. Using multivariable analysis, the only predictor of penile sensation loss ≥6 months was a duration of operation >4 hours (odds ratio = 2.1; 95% confidence interval = 1.2-3.0; P < .01). CLINICAL IMPLICATIONS: The study highlights the need during patient consent to discuss penile sensation loss. Patients should be informed that rates of penile sensation loss ranges from 2-30% and most patients will have complete resolution of any sensation loss within one year of follow-up. STRENGTH AND LIMITATIONS: To our knowledge no other studies have described the chronology and severity of penile sensation following PIG, our study demonstrates the utility of biothesiometry in measuring penile sensation before and after PIG. Number of patients and absence of control group represent a limitation. CONCLUSION: Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring >12 months. Longer operations appeared to be more likely associated with sensation loss. Terrier JE, Tal R, Nelson CJ. Penile sensory changes after plaque incision and grafting surgery for Peyronie's disease. J Sex Med 2018;15:1491-1497.


Assuntos
Induração Peniana/cirurgia , Pênis/fisiopatologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/fisiopatologia
16.
J Sex Med ; 15(10): 1506-1513, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30177471

RESUMO

INTRODUCTION: The sliding technique (ST), commonly done with a subcoronal circumcising incision with penile degloving, has been used to restore penile size in patients with severe Peyronie's disease (PD) and erectile dysfunction, but with a potential risk of ischemic injury to the glans penis. AIM: To provide detailed surgical techniques regarding the nondegloving ventral incision and report our initial experience with this approach to perform the ST and penile prosthesis placement in patients with severe PD. METHODS: This was a retrospective review of patient outcomes after penile prosthesis placement with penoplasty for severe PD and erectile dysfunction from January 2015 to December 2017. MAIN OUTCOME MEASURES: Primary outcomes included straightening rates, penile measurement, along with immediate and late complications. Secondary outcomes include operative time and overall patient satisfaction. RESULTS: 12 Patients had significant penile atrophy and/or curvature >60 degrees and underwent inflatable penile prosthesis placement with grafting procedure. Significant penile atrophy was determined by a combination of the patient's subjective report and the surgeon's objective assessment through stretched penile length. 7 (58.3%) of those patients underwent ST, of which the last 5 had the procedure performed through a nondegloving ventral incision. Mean degree of curvature prior to ST was 66 degrees (45-90 degrees). Mean penile length gain was 2.6 cm (2.0-3.0 cm). At a mean follow-up of 15.5 months (3-31 months), only 1 patient had minimal residual curvature of 15 degrees. There were no vascular complications. CLINICAL IMPLICATIONS: This nondegloving technique theoretically maintains blood flow continuity to the glans penis by preserving the continuity of the skin, dartos fascia, and neurovascular bundle. STRENGTHS & LIMITATIONS: Strengths of this study include the novel nature of this approach, no incidence of vascular complications, and adaptability to other grafting procedures during penile prosthesis placement. Limitations include the use of 5-item International Index of Erectile Function scores to assess preoperative erectile function on PD, small population, longer incision, and a possible steep learning curve. CONCLUSION: While ischemic complications of ST and penile prosthesis implantation are rare, there are reports of ischemic injury in patients undergoing a subcoronal circumcising incision with penile degloving. The non-degloving technique with ventral incision provides for an alternative method for ST and penile prosthesis placement to maintain dartos and skin continuity to the glans penis while still allowing for adequate surgical exposure. Clavell-Hernández J, Wang R. Penile Size Restoration With Nondegloving Approach for Peyronie's Disease: Initial Experience. J Sex Med 2018;15:1506-1513.


Assuntos
Implante Peniano/métodos , Induração Peniana/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Induração Peniana/fisiopatologia , Prótese de Pênis/efeitos adversos , Estudos Retrospectivos
17.
Zhonghua Nan Ke Xue ; 24(1): 55-58, 2018.
Artigo em Chinês | MEDLINE | ID: mdl-30157361

RESUMO

Objective: To investigate the clinical effect of plaque excision plus autologous perididymal patch grafting in the treatment of Peyronie's disease. METHODS: This study included 10 patients with Peyronie's disease received in our Department of Urology between January 2013 and December 2015, who had failed to respond to over 12 months of expectant drug therapy and remained stable for more than 6 months, none able to perform sexual intercourse due to penile curvature (>60°). All the patients underwent plaque excision plus autologous perididymal patch grafting. RESULTS: Postoperative follow-up ranged from 6 to 24 months. All the patients achieved normal penile erection, without testicular atrophy, torsion or necrosis at the surgery side and all were satisfied with the surgical results without complaining about obvious penile shortening. CONCLUSIONS: Plaque excision plus autologous perididymal patch grafting is a safe, simple, economic and effective method for the treatment of Peyronie's disease.


Assuntos
Induração Peniana/cirurgia , Pênis/cirurgia , Transplantes , Epididimo/transplante , Seguimentos , Humanos , Masculino , Ereção Peniana , Induração Peniana/patologia , Pênis/patologia , Fatores de Tempo
18.
Andrology ; 6(6): 909-915, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30076677

RESUMO

BACKGROUND: Peyronie's Disease (PD) is an acquired connective tissue disorder that often leads to penile curvature (PC) and sexual dysfunction. Penile lengthening procedures (PLP) with four-layered porcine small intestinal submucosa graft (Surgisis® ES; Cook) have been widely used in patients with severe PC when erectile function is preserved. However, complications such as erectile dysfunction (ED) may limit treatment satisfaction. OBJECTIVES: Focusing on patients perspective, our study aims to evaluate longterm patient-reported outcomes, satisfaction, and dissatisfaction predictors after PLP. MATERIAL AND METHODS: This prospective study included 32 patients affected by PD with severe PC submitted to PLP with Surgisis® ES between 2011 and 2014. All patients were submitted to a standardized protocol with regular clinical evaluation at 3, 6 and 12 months, and yearly thereafter. After the third year follow-up, IIEF-5, modified EDITS and an additional non-validated questionnaire were completed. RESULTS: Concerning the surgical procedure, the mean tunical defect area (TDA) was 15.9 ± 6.9 cm2 . The mean follow-up time were 49.6 ± 12.7 months and there was a significant increase in stretched penile length (p = 0.01). Postoperative erectile function as assessed by IIEF-5 was positively correlated with overall treatment satisfaction evaluated through EDITS (p = 0.01). TDA was negatively correlated with postoperative IIEF-5 (R = -0.56, p < 0.001). TDA ≥ 14.375 cm2 can predict ED with 76.9% sensibility and 58.3% specificity. Moreover, TDA ≥ 21.875 cm2 can predict clinically significant ED (IIEF-5 score ≤17) with 80% sensibility and 95.2% specificity. Patient-reported longterm complications were 65.6% decreased penile length, 56.5% diminished rigidity and 25% curvature recurrence. CONCLUSION: PLP using a Surgisis® ES is a valuable surgical option for the treatment of PD with severe PC. Although it results in high rates of long-term patient-reported overall satisfaction, possible outcomes such as postoperative ED must be acknowledged. TDA is a strong predictor for postoperative ED and should be considered in clinical practice to classify patients in low- or high-risk for postoperative ED.


Assuntos
Disfunção Erétil/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Satisfação do Paciente , Ereção Peniana , Induração Peniana/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Animais , Disfunção Erétil/patologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/patologia , Induração Peniana/fisiopatologia , Induração Peniana/psicologia , Pênis/patologia , Pênis/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Inquéritos e Questionários , Sus scrofa , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
19.
Actas urol. esp ; 42(6): 414-419, jul.-ago. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-174745

RESUMO

Introducción: El pene curvo congénito es una enfermedad relativamente rara, dada por una desviación del pene en comparación con el eje recto del cuerpo cuando se encuentra en erección. La prevalencia es difícil de determinar. Si bien indican que podría afectar hasta a un 10% de la población masculina, la mayoría de estas desviaciones son menores, sin implicancia clínica ni psicológica, lo que determinaría el subdiagnóstico. La corrección efectiva de la desviación puede mejorar marcadamente la calidad de vida de estos adolescentes. Objetivo: Evaluar la calidad sexual de los pacientes con diagnóstico de pene curvo congénito a quienes se les realizó la corrección quirúrgica. Materiales y métodos: Diseño: estudio de cohortes retrospectivo, observacional. Se recabaron los datos de las historias clínicas de los pacientes a los que se les realizó la corrección quirúrgica de pene curvo congénito entre junio del 2004 y agosto del 2016. A todos los pacientes se les efectuaron los siguientes cuestionarios autoadministrados: Sexual Quality of Life Questionnaire-Male (SQOL-M), International Index of Erectile Function 5 (IIEF 5) y "¿Cuán satisfecho está con los resultados de la cirugía? De "0 a 10". Resultados: Se realizaron 22 corporoplastias para la corrección de pene curvo congénito. El promedio de edad de los pacientes fue de 23,4 años (r 17-35). La media de grados de desviación previo a la cirugía fue de 47,9° (r = 20-90°). El puntaje promedio tras responder el cuestionario SQOL-M fue de 52 puntos (r = 6-66). Los resultados al responder el IIEF 5 fue de 22,4 puntos. Conclusión: El pene curvo congénito disminuye profundamente la calidad de vida y el tratamiento quirúrgico temprano es fundamental para reparar la deformidad anatómica y, así, restaurar significativamente el bienestar psicosocial y sexual de los pacientes


Background: Congenital penile curvature is a relatively rare disease, resulting from a deviation of the penis from the body's straight axis when erect. The prevalence is difficult to determine. Although it has been suggested that the condition could affect up to 10% of the male population, most of these deviations are minor, with no clinical or psychological importance, which leads to its underdiagnosis. Effective correction of the deviation can markedly improve the quality of life of adolescents with this condition. Objective: To assess the quality of the sex life of patients diagnosed with congenital penile curvature who underwent surgical correction. Materials and methods: Design Retrospective, observational cohort study. Data was collected from the medical records of patients who underwent surgical correction of congenital penile curvature from June 2004 to August 2016. The patients completed the following self-administered questionnaires: Sexual Quality of Life Questionnaire-Male (SQOL-M), International Index of Erectile Function 5 (IIEF 5) and "How satisfied are you with the results of the surgery? From 0 to 10". Results: Twenty-two corporoplasties were performed to correct the patients' congenital penile curvature. The patients' average age was 23.4 years (range, 17-35). The mean deviation prior to surgery was 47.9° (range, 20°-90°). The average score on the SQOL-M was 52 points (range, 6-66). The average score on the IIEF 5 was 22.4 points. Conclusion: Congenital penile curvature profoundly decreases quality of life, and early surgery is fundamental for repairing the anatomical deformation and thereby significantly restores the patients’ psychosocial and sexual wellbeing


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Satisfação do Paciente , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Induração Peniana/cirurgia , Pênis/cirurgia , Qualidade de Vida , Estudo Observacional , Ereção Peniana , Pênis/anormalidades , Estudos Retrospectivos , Estudos de Coortes , Inquéritos e Questionários
20.
Int J Impot Res ; 30(6): 306-311, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29973699

RESUMO

Ventral penile curvature in Peyronie's disease (PD) is not very common but may lead to inability for sexual intercourse, especially in severe cases > 60°. Ventral curvatures are most often addressed surgically with plication owing to fear of urethral complications, as it requires the mobilisation of the urethra. In this study, the ventral sealing technique is introduced for correction of ventral curvatures in patients with PD. The surgical approach includes the mobilisation of the neurovascular bundle and the urethra. At the point of maximum curvature on the ventral aspect of the penis, a partial plaque excision is performed and the resulting tunical defect is sealed (closed) with a self-adhesive collagen fleece (TachoSil®, Baxter, IL, USA) that does not require suture fixation. Twelve patients with severe ventral curvature were included in this study. Mean penile curvature was 98.3° (sd ± 27.6, range: 60-150). Mean operative time was 99.2 minutes (sd ± 12.4, range: 80-130). Mean follow-up was 17.9 months (sd ± 8.0, range: 9-29). Ten out of 12 patients (83.3%) showed a totally straight penis. Two patients (16.7%) had a residual curvature of < 30°, which did not interfere with sexual intercourse. All patients were able to perform satisfying sexual intercourse. Initial results of the ventral sealing technique are encouraging. However, long-term data are necessary.


Assuntos
Colágeno , Disfunção Erétil/etiologia , Disfunção Erétil/cirurgia , Induração Peniana/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Ereção Peniana , Induração Peniana/complicações , Induração Peniana/patologia , Pênis/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
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