Surgical management of Peyronie's disease
- William O Brant, MD, FACS, FECSM
William O Brant, MD, FACS, FECSM
- Veterans Affairs Medical Center, Salt Lake City, UT
- Anthony J Bella, MD, FRCSC
Anthony J Bella, MD, FRCSC
- Assistant Professor of Urology and Associate Scientist, Neuroscience
- Endowed Chair in Men's Health Research
- Greta and John Hansen Chair in Men's Health Research
- University of Ottawa
- Tom F Lue, MD, ScD (Hon), FACS
Tom F Lue, MD, ScD (Hon), FACS
- Professor and Vice Chair
- Emil Tanagho Endowed Chair in Clinical Urology
- Department of Urology
- University of California, San Francisco
Peyronie's disease, an acquired, localized fibrotic disorder of the tunica albuginea, can cause significant penile deformity and lead to sexual dysfunction and psychological trauma (figure 1). The nature and extent of Peyronie's plaque, and therefore severity or complexity of penile deformity, varies widely.
Early medical intervention is the first line of therapy and is likely to be more effective when the disease is evolving, although new medications such as collagenase may play an important role in even stable disease. Once Peyronie's disease has reached a stable phase, surgery may be offered, but only for penile deformity that compromises sexual function.
This topic will review the indications for surgery in Peyronie's disease, approaches to surgical correction, and complications of surgical management.
The diagnosis and medical management of Peyronie's disease are discussed elsewhere. (See "Peyronie's disease: Diagnosis and medical management".)
Surgical management is indicated for patients whose Peyronie's disease has persisted for more than 12 months and is associated with a penile deformity compromising sexual function. It is important to delay surgery until Peyronie's disease has been stable for at least three months because surgical results can be compromised by active disease [1,2].
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- SURGICAL INDICATIONS
- PREOPERATIVE EVALUATION
- Duplex evaluation of erectile capacity
- Preoperative penile photographs/measurements
- Choice of surgical approach
- Patient counseling
- SURGICAL ANATOMY
- Tunica albuginea
- Neurovascular bundle
- GENERAL APPROACH
- - Graft materials
- Penile prosthesis
- POSTOPERATIVE CARE
- Pain management
- Patient instructions
- Sexual activity
- FOLLOW-UP CARE
- Erectile dysfunction
- Graft complications
- Penile implant complications
- SUMMARY AND RECOMMENDATIONS