The penile disassembly technique in the surgical treatment of Peyronie's disease.

Abstract

To present an approach for treating Peyronie's disease, using the penile disassembly technique for reconstructive surgery. From November 1996 to September 2000, 74 patients with Peyronie's disease were treated surgically. The penile disassembly technique was used in 46 of the patients (mean age 51 years, range 21-63). The indications were severe penile deviation under the glans cap, plaque in the distal third of the corpora cavernosa with the 'hour-glass' phenomenon, and more than one plaque at different sites. The corporal bodies are separated from the glans, neurovascular bundle and urethra. The technique enables the complete preservation of all structures of the neurovascular bundle, especially if it is incorporated into the plaque. The method provides an excellent approach to the repair of all deformities on the completely free corpora cavernosa and that are affected by the plaque. In the plaque region, incisional grafts are placed using full-thickness penile skin or saphenous vein. The technique also enables reduction corporoplasty, i.e. amputation of the tips of the corpora cavernosa that include plaque, in those with sufficient penile length. Penile re-assembly involves joining the glans, neurovascular bundle, urethra and repaired corpora cavernosa into their normal anatomical relationships. The mean (range) follow-up was 27 (6-53) months. The penis was completely straightened in 40 patients (87%) but the deviation recurred in six. In four patients the deformity was <10 degrees and in two was <20 degrees. Penile shortening occurred in 9% of the patients. There was no evidence of inflammation or infection after surgery. There were no injuries of either the neurovascular bundle or urethra. The penile disassembly technique could be a good alternative to other surgical techniques in treating selected patients with Peyronie's disease; it allows an excellent approach to penile deformities which can then be easily and safely corrected.