Surgical Treatment Of Peyronie's Disease Research Articles

Chronological perspective of substitute materials used for the surgical treatment of Peyronie's disease: A scoping review of literature.

This comprehensive scoping review aimed to identify all up-to-date original publications relating to substitute materials used for the surgical treatment of Peyronie's disease (PD), and characterize what material in which chronological trends were published in the current literature. Using the PCC framework (P: population, C: concept, and C: context), a search strategy was developed and used in four electronic databases, in addition to the Google scholar. All current published, in-press, and pre-print manuscripts with available English full-text were included. Eligible studies were required to be original research articles of any study design, reporting the usage of grafts on surgical treatment of PD. Included studies were reported in a narrative synthesis format. A total of 3379 articles were identified via an electronic search of databases and a total of 171 articles entered this scoping review. Most studies originated from Europe (n = 72) and North America (n = 66). Reports from the other continents increase in number in the 21st century. Highest number of the published papers was seen in 2001 to 2005 pentad. Autologous grafts (53.5%). Allografts (22.7%) and xenografts (15.7%) were the most frequently reported materials. Time flow of the used material and the alterations in trends for them is quite considerable. A global perspective of relevant publications on substitute materials in the surgical management of PD is presented in this review. The information in this summary may assist in establishing future research priorities in this area.

Cost of Intralesional Collagenase Clostridium Histiolyticum Therapy Versus Surgery for the Management of Peyronie's Disease: A Claims-Based Analysis (2009-2019).

BackgroundCollagenase Clostridium histolyticum (CCH), which was approved by the FDA for the treatment of Peyronie's disease (PD) in 2013, may obviate the need for surgery but its historically high cost must be considered when offering CCH vs surgical intervention to affected patients.AimTo compare trends of intralesional injections vs surgical treatment for PD and assess the contemporary cost of treatment with CCH vs surgical intervention.MethodsWe reviewed 2009–2019 MarketScan Commercial Claims data to identify all men 18 years and older with PD. CPT and HCPCS codes were used to identify PD treatments for each patient. Associated insurance claims in USD were summed for each treatment type.OutcomesTotal and out-of-pocket costs, as well as frequencies, for treatments were calculated on a yearly basis and the Cochran-Armitage test was used to compare frequencies before and after FDA approval of CCH.ResultsOf 89,205 men diagnosed with PD, 21,605 (24.2%) underwent treatment; most required only intralesional injections, however 1,519 (7.0%) received only surgical therapy and 1,951 (9.0%) required medical and surgical therapy. Intralesional CCH use sharply increased after its FDA-approval in 2013 with a concomitant fall of intralesional verapamil use. The use of both surgical plication and plaque grafting decreased steadily from 2009 to 2019. The median cost per patient for all 3 treatments increased over the study time-period: $1,856 to $3,196 for plication, $2,233 to $3,631 for plaque grafting, and $6,940 to $8,895 per cycle for CCH. Out-of-pocket median patient contribution for plication, plaque grafting, and per cycle intralesional CCH injection were similar over the study period and never exceeded $300.Clinical ImplicationsCCH is significantly more expensive than any surgical treatment option, however, the out-of-pocket patient contribution for surgery and CCH are similar.Strengths & LimitationsThis study incorporated all procedure costs and is the most contemporary, comprehensive, and accurate reflection of overall and out-of-pocket costs to patients for surgical and intralesional PD therapies. We anticipate these data to allow for a more complete discussion between patients and providers regarding their care. The use of a commercial claims database prohibited assessment of post-procedural costs and treatment outcomes.ConclusionCCH use has increased significantly since its FDA approval in 2013 with out-of-pocket patient contribution comparable to surgical therapy despite significantly higher total treatment costs.Walton EL, Quinn TP, Mulloy E, et al. Cost of Intralesional Collagenase Clostridium Histiolyticum Therapy Versus Surgery for the Management of Peyronie's Disease: A Claims-Based Analysis (2009–2019). Sex Med 2022;10:100517.

Surgical treatment of Peyronie disease

We present the results of operative treatment of 25 men with Peyronie disease. Indications for surgical treatment included plaques > 1.5 cm and a penile curvature angle > 45°. In total, 11 patients underwent plaque plication of the penis following the method of P.A. Shcheplev, 5 patients underwent substitutive corporoplasty of plaque using the large saphenous vein of the thigh, 5 patients underwent patchwork сorporoplasty using xenopericardium, and 4 patients underwent corporoplasty using buccal mucosa graft. The results of the operative treatment of all patients were considered positive. In conclusion, operative treatment of patients with Peyronie disease undergoing corporoplasty replacement is indicated for plaque stabilization, particularly while using xenopericardium. (For citation: Kalinina SN, Fesenko VN, Nikolskii AV, Burlaka OO. Surgical treatment of Peyronie disease. Urologicheskie vedomosti. 2018;8(2):24-29. doi: 10.17816/uroved8224-29).

Small Intestinal Submucosa Grafting for Peyronie Disease: Outcomes and Patient Satisfaction

To evaluate surgical outcomes and complications and assess overall patient satisfaction after small intestinal submucosa (SIS) grafting for Peyronie disease. Twenty-eight patients were treated with tunical incision and grafting with SIS. Mean age of the patients was 58 (range: 43-71) years. A preoperative protocol was applied to all patients. Patients were also evaluated at follow-up clinic visits. The International Index of Erectile Function, a modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, postoperative self-reports, and clinical characteristics were used to measure outcomes. Hypertension, hypercholesterolemia, and type 2 diabetes were reported in 53,6%, 46,4%, and 28,6% of patients, respectively. Previous penile trauma was reported by 10,7%. The mean operative time was 151 ± 23 minutes. Average follow-up was 18 months (range: 3-36). The only surgical complication was 1 case of infected hematoma treated with surgical drainage. Self-reported complete resolution of curvature was 82,1%. Subjective perception of penile shortening was reported by 71,4% of patients. However, only 4 patients objectively showed postoperative penile shortening. Erectile function was completely preserved in 64,2%. Four patients complained of erectile dysfunction despite medication, even though no objective vascular etiology was shown on postoperative penile Doppler ultrasound. Overall, 82,2% of patients reported high levels of satisfaction. Surgical treatment of Peyronie disease using SIS grafting is a safe option, with low rate of major complications. It has good surgical outcomes and high patient satisfaction rates.

La maladie de Lapeyronie

Lapeyronie's disease is a common condition affecting 3.4 to 9% of the male population. Knowledge of pathophysiology, natural history, and treatment outcomes can guide the care of patients. A literature review was carried out between 1940 and 2012 in Pubmed using the keywords: Lapeyronie's disease, Peyronie's disease (PD), pathophysiology of PD, surgical treatment for PD, medical treatment for PD. Seventy-five articles were selected, including original articles, reviews, and recommendations in English or French. Few studies available are of level 1 and most of them are of 2b and 3 level of evidence. The pathophysiology of Lapeyronie's disease is controversial. Medical treatments are ineffective. Surgery should be proposed when the curvature is stabilized, and the treatment of the concavity or convexity depends on the size of the erect penis, its curvature angle and erectile function. Penile implant must be proposed to patients when erectile dysfunction is combined with severe curvature.

A Reappraisal of Saphenous Vein Grafting

Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

Small intestinal submucosa for patch grafting after plaque incision in the treatment of Peyronie's disease

Report the results using porcine small intestinal submucosa (SIS) as a graft material in the surgical management of Peyronie's disease (PD). We performed a retrospective chart review of men with PD who underwent surgical correction of the curvature by plaque "H" incision and patch grafting with 4-ply SIS (Cook, Bloomington, IN) by a single surgeon at our institution. Degree and direction of curvature, sexual function, and co-morbidities were assessed pre- and postoperatively. Thirteen patients were identified. Mean age was 57 +/- 8, range 42-70 years. Median follow-up was 14 months, range 3-89 months. At presentation, all reported penile curvature. Also reported were difficulty with vaginal penetration (determined by question number 2 of the sexual encounter profile questionnaire - SEP2), palpable plaque, hourglass deformity, difficulty with firmness, and difficulty with sustaining erection (determined by SEP3) in 77%, 69%, 77%, 62%, and 46% of patients, respectively. Mean and median degrees of curvature of the primary deformity were 71 and 67.5 degrees, respectively. Three patients had secondary curves of less than 30 degrees in a different direction. Mean and median plaque size were 3.5 and 2.7 cm2, respectively. Seven patients had one graft and six patients had two grafts placed with a mean size of 15 +/- 0 cm2. For the patient with PD, SIS grafting can achieve a functionally straight erection with durable results yet with relatively high rates of erectile dysfunction. SIS is a viable graft material for use in the surgical treatment of PD.

New surgical treatment for peyronie disease

Five patients with Peyronie disease were treated successfully with a surgical technique derived from Nesbit's technique for the treatment of congenital curvature of the penis. Excision of ellipses of tunica albuginea from the convex side of the penis as described by Nesbit was not done, but instead the tunica was reeved with nonresorbable sutures to achieve straightening. The surgical technique combined with prior radiotherapy was successfully applied to patients with severe forms of Peyronie disease. More experience is necessary to establish the value of the proposed treatment concept.

Use of dacron patch graft in peyronie disease

A Dacron patch graft for surgical correction of Peyronie disease was used in 4 patients. Results were satisfactory as far as the correction of the penile deformity and resolution of the pain during erection were concerned. No change was found in the patients' potency except in 1 patient whose potency has improved postoperatively. A penile prosthesis was inserted subsequently in 1 patient with decreased potency preoperatively. We conclude that this is a useful and simple surgical treatment for Peyronie disease.

Surgical treatment of peyronie disease with dacron graft

Four severe cases of Peyronie disease treated with plaque excision and insertion of a Dacron graft are presented. All 4 patients have had encouraging results, with follow-up ranging from six months to three and one-half years. They have little or no penile curvature, and all are capable of intercourse. One patient had a wound infection and skin slough necessitating pedicle grafting; but the Dacron graft was saved, and the patient has done well subsequently.