PD20-07 THE CHRONOLOGY AND SEVERITY OF PENILE SENSORY CHANGES AFTER PLAQUE INCISION AND GRAFTING SURGERY FOR PEYRONIE’S DISEASE.

Abstract

INTRODUCTION AND OBJECTIVES: Besides changes in erectile function, Plaque incision and grafting surgery (PIGS) when performed dorsally, is known to be associated with penile sensory loss. Rates of sensory changes in the literature have been cited at 0-12%. This analysis was conducted to define the rate, chronology and predictors of this problem at our center. METHODS: The study population consisted of men who (i) had dorsal PIGS for PD and (ii) had at least 6 months follow-up. Patients are routinely followed up in the office at 1 week, 1 month and 6 months and by phone at 12 months and later if continued problems exist. Penile sensation was graded on visual analog 0-10 point scale, where 10 was perfect sensation and 0 total loss of sensation. The degree of sensation loss was defined as extensive if circumferential, patchy if diffuse and focal if small and confined to one area of the penile shaft. Using multivariate analysis, predictors of sensation loss were sought including: patient age, diabetes presence, duration of PD, duration of operation. RESULTS: 60 patients were analyzed. Mean age 1⁄4 52 20 years, mean follow-up of 16 11 months. Mean duration of PD at time of PIG surgery 1⁄4 18 11 months. 10% had diabetes preop with a mean HBA1C 1⁄4 7.2 1.8%. Mean duration of self-reported stability 1⁄4 8 months. 75% of patients had curvature alone, while the remainder had associated indentations or hourglass deformity. Mean baseline primary curvature 1⁄4 64 28 degrees. All patients were capable of sexual intercourse pre-operatively with or without erectogenic aids. Mean duration of operation 1⁄4 3.5 1.8 hours. 20% had any sensation loss at 1 week, 20% at 1 month and 7% at 6 months. Severity presented in Table. 2/60 patients had some sensation loss at 1 year and a single patient at 2 years continued to have extensive sensation loss on the glans and distal shaft. Only duration of operation was a predictor, with duration >4 hours being predictive of sensation loss at 6 months, OR 2.1, 95% CI 1.2-3.0 (p<0.01). CONCLUSIONS: Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring beyond 12 months. Longer operations are more likely associated with sensation loss, likely related to difficult neurovascular bundle elevation.