ORIGINAL RESEARCH—SURGERY: A Surgical Algorithm for Men with Combined Peyronie's Disease and Erectile Dysfunction: Functional and Satisfaction Outcomes

Abstract

Men with Peyronie's disease who also have erectile dysfunction represent a challenge to the urologist. Historically, penile prosthesis surgery has been the management strategy of choice for this population. This study was undertaken to define the outcomes of a penile reconstructive surgery algorithm in men with Peyronie's disease and concomitant erectile dysfunction (ED). Patients presenting with combined Peyronie's disease and erectile dysfunction were treated with vasoactive therapy initially. All patients underwent dynamic infusion cavernosometry and cavernosography. Nonresponders to erectogenic pharmacotherapy were advised to undergo penile prosthetic surgery. Responders to erectogenic therapy were considered candidates for either corporoplasty or plaque incision and grafting. The International Index of Erectile Function (IIEF) questionnaire was used to compare erectile function and satisfaction profiles serially pre- and postoperatively between the patients in the three groups. Sixty-two patients constituted the study population. Eighty-one percent of the patients responded to erectogenic pharmacotherapy. Postoperative IIEF erectile function domain scores were statistically higher for implant patients and lower for plaque incision and grafting patients compared to preoperative scores. Postoperative IIEF satisfaction domain scores were higher for corporoplasty and implant patients and lower for plaque incision and grafting patients compared to preoperative scores. The surgical algorithm used in this study leads to excellent IIEF erectile function and satisfaction scores for corporoplasty and implant patients; however, plaque incision and grafting patients had poor functional and satisfaction outcomes. These data support the concept that not all men with combined ED and Peyronie's disease require penile prosthetic surgery, and furthermore, plaque incision and grafting surgery is a poor option for men with combined disease.