The comparison of success status and complications in peyronie disease patients: penile plication versus plaque incision and grating techniques

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Aims: This study aimed to evaluate and compare the outcomes of tunical lengthening and shortening techniques for the surgical management of Peyronie's disease (PD) in terms of penile length, patient satisfaction, and complications.
 Methods: A retrospective analysis was conducted on PD patients who underwent surgical procedures between January 2017 and May 2023 at a single institute. Patient demographics, comorbidities, penile curvature, penile length, and surgical techniques were evaluated. The surgical procedures included plaque incision and grafting, and tunical plication. Post-operative data, including penile length, residual curvature, patient satisfaction, adverse events, and erectile function, were collected at 1-12 months of surgery. 
 Results: A total of 36 patients (mean follow-up period: 432.25±121.14 days) underwent surgical procedures for PD. Penile length in the tunical lengthening group (13.04±1.62 cm) was significantly longer than in the tunical shortening group (10.85±1.24 cm, p=0.001). Tunical shortening procedures were associated with a higher rate of penile shortening (57.1% vs. 6.7%, p=0.001) and suture-related discomfort (38.1% vs. 6.7%, p=0.031) compared to tunical lengthening procedures. Patient satisfaction was higher in the tunical lengthening group (80% vs. 66.7%, p=0.378). There was no significant difference in painful erection during penetrations or incapability of intercourse between the groups. The average length of hospital stay was longer for tunical shortening surgery compared to tunical lengthening surgery (1.27±0.27 vs. 1.79±0.39, p=0.023).
 Conclusion: Tunical lengthening procedures demonstrated superior outcomes in terms of penile length and suture-related discomfort compared to tunical shortening procedures for the surgical management of PD. Patient satisfaction was also higher in the tunical lengthening group. Clinicians should consider various factors when selecting the appropriate surgical technique for PD, including penile length, the degree of penile curvature, and surgeon experience. Prospective randomized studies are needed to further validate these findings and assess long-term outcomes.