A Retrospective Comparative Study of Traction Therapy vs. No Traction Following Tunica Albuginea Plication or Partial Excision and Grafting for Peyronie's Disease: Measured Lengths and Patient Perceptions

Abstract

Loss of penile length is a recognized and common consequence of Peyronie's disease (PD). Traction therapy (TT+) has been reported to decrease post-op length loss as well as increase stretched penile length (SPL) prior to surgery. The aim of this study was to study patient outcomes with penile length change and patient satisfaction after surgery following tunica albuginea plication (TAP) and partial plaque excision and grafting (PEG) with or without postoperative TT. Retrospective analysis was performed from our cohort of Peyronie's reconstructive surgery between 2007 and 2010. SPL was measured dorsally from pubis to corona and recorded at the initial office visit and then compared to most recent postoperative visit. Patients were then stratified by procedure and whether TT was used (TT+ and TT-; TAP N = 52 [27 TT+ and 25 TT-] and PEG N = 59 [36 TT+ and 23 TT-). Traction therapy was initiated for >2 hours a day for 3 months typically starting 3-4 weeks postoperatively. A non-validated mailed questionnaire assessed patient perceptions. Mean length change seen in TAP (TT+) was 0.85 cm (0.25-1.75) vs. -0.53 cm (-1.75 to 0.5) in TAP (TT-) (P < 0.001). The mean length change seen in PEG (TT+) was 1.48 cm (0-6) vs. PEG (TT-) 0.24 cm (-1 to 2.5 cm) (P < 0.001). Sixty-one percent of surveys were returned; 85% lost length prior to the initial office evaluation, with an average of -2.5 cm lost. Importantly, in those who used traction, there was no perceived length loss, 58% reported a mean erect length gain of 1.1 cm. However, only 54% of all patients were satisfied with their current erect length. Loss of length in men with PD remains a serious concern. It appears that postoperative TT can result in length preservation, and in many, a measured and perceived length gain following correction of the curvature.