MP67-02 DOES PRE-OPERATIVE PENILE ULTRASOUND HELP WITH SURGICAL PLANNING IN PATIENTS WITH PEYRONIE'S DISEASE AND ERECTILE DYSFUNCTION?

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018MP67-02 DOES PRE-OPERATIVE PENILE ULTRASOUND HELP WITH SURGICAL PLANNING IN PATIENTS WITH PEYRONIE'S DISEASE AND ERECTILE DYSFUNCTION? Dorota Hawksworth, Emad Rajih, Osama Ali, and Arthur Burnett Dorota HawksworthDorota Hawksworth More articles by this author , Emad RajihEmad Rajih More articles by this author , Osama AliOsama Ali More articles by this author , and Arthur BurnettArthur Burnett More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) defined as chronic inflammation of the tunica albuginea, is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. PD affects an estimated 5% of men and results in penile pain, abnormal curvature, penile shortening and/ or erectile dysfunction (ED). About 20-30% of patients with PD have concomitant ED refractory to medical therapy and may benefit from a combined procedure addressing both conditions. Prior reports demonstrate that the majority of patients with PD-type penile deformity required adjunctive corrective procedures (modeling, plaque incision, incision/ excision and grafting) at time of inflatable penile prosthesis (IPP) placement, and only 4% achieved spontaneous curvature correction with IPP placement alone. Our objective is to correlate pre-operative penile examination and penile ultrasound results to intra-operative findings in order to reliably predict need for adjunctive corrective procedures at time of IPP placement. METHODS Prospectively collected database of 898 consecutive records of patients who underwent inflatable penile prosthesis (IPP) placement at our institution between May 2007 and March 2017 was queried. Medical records of patients with concomitant PD and ED diagnoses were further evaluated. Patient demographics, pre-operative workup and intra-operative data were reviewed. Patients with no documented pre-operative penile examination and penile ultrasound were excluded from this review. Based on the complexity of the straightening procedures performed, patients were divided into three sub-categories:1. Mild (modeling only), 2. Moderate (modeling/corporoplasty, corporoplasty alone, corporoplasty/modeling and scar excision alone), 3. Severe (corporoplasty/modeling with Allograft placement, corporoplasty with Nesbit, scar excision/corporoplasty and scar excision with Allograft placement). Standard statistical calculations were utilized. RESULTS Out of 898 patient records, 62 were identified and further reviewed. Average patient's age was 60yo (42-81 yo). 54 out of 62 (87.1%) patients reported a penile deformity at time of pre-operative consultation and 43/60 (71.67%) had an abnormal penile examination consistent with PD. 8 (12.9%) patients with no reported pre-operative curvature and normal exam were diagnosed with penile deformities intra-operatively and necessitated further straightening maneuver(s). Pre-operative examination diagnostic of PD correlated with intra-op findings in 41/60 (68%) of all presenting patients. PPV of an abnormal pre-operative examination was 71.43% with a sensitivity of 93%.39 (62.9%) patients had a pre-operative penile duplex ultrasound performed, and out of those 92.31% demonstrated a penile tissue abnormality suggestive of PD. The ultrasound findings correlated with intra-operative findings in 91.89% of the patients. Four of the six patients requiring the most complex adjunctive corrective procedures had tunical calcifications present on the pre-operative sonographic evaluation. Additionally, those cases prolonged the total operative time by an average of 75 minutes. CONCLUSIONS In our referral population, 13% of patients presenting for IPP placement, who had normal pre-operative penile examination and no reported penile curvature, were observed to have a significant penile curvature intra-operatively and needed a concomitant straightening procedure. Confirmation of a penile tissue abnormality on pre-operative ultrasound has the highest predictive value for need of additional straightening maneuvers during IPP placement in patients with concomitant ED and PD. Penile ultrasonography appears to be a good surrogate for a penile examination, as it has a high sensitivity for detection of PD. Tunical calcifications identified on pre-operative ultrasound help predict necessity of more advanced straightening techniques and additional operative time required to achieve successful surgical outcome. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e907-e908 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dorota Hawksworth More articles by this author Emad Rajih More articles by this author Osama Ali More articles by this author Arthur Burnett More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...