Surgical management of Peyronie's disease
- William O Brant, MD, FACS, FECSM
William O Brant, MD, FACS, FECSM
- Associate Professor of Surgery (Urology)
- Center for Reconstructive Urology and Men's Health
- Department of Surgery (Urology) University of Utah
- 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 the 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].
- Kadioglu A, Akman T, Sanli O, et al. Surgical treatment of Peyronie's disease: a critical analysis. Eur Urol 2006; 50:235.
- Dean RC, Lue TF. Peyronie's disease: advancements in recent surgical techniques. Curr Opin Urol 2004; 14:339.
- Ralph DJ, Garaffa G, García MA. Reconstructive surgery of the penis. Curr Opin Urol 2006; 16:396.
- Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. J Urol 2015; 194:745.
- Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie's disease. J Urol 1997; 158:2149.
- Kadioglu A, Tefekli A, Erol B, et al. A retrospective review of 307 men with Peyronie's disease. J Urol 2002; 168:1075.
- Greenfield JM, Lucas S, Levine LA. Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol 2006; 175:238.
- Taylor FL, Levine LA. Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up. J Sex Med 2008; 5:2221.
- Brant WO, Bella AJ, Garcia MM, et al. Surgical Atlas. Correction of Peyronie's disease: plaque incision and grafting. BJU Int 2006; 97:1353.
- Dugi DD 3rd, Morey AF. Penoscrotal plication as a uniform approach to reconstruction of penile curvature. BJU Int 2010; 105:1440.
- Adibi M, Hudak SJ, Morey AF. Penile plication without degloving enables effective correction of complex Peyronie's deformities. Urology 2012; 79:831.
- Ralph DJ, al-Akraa M, Pryor JP. The Nesbit operation for Peyronie's disease: 16-year experience. J Urol 1995; 154:1362.
- Yachia D. Modified corporoplasty for the treatment of penile curvature. J Urol 1990; 143:80.
- Brant WO, Bella AJ, Lue TF. 16-Dot procedure for penile curvature. J Sex Med 2007; 4:277.
- Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol 2002; 167:2066.
- Ralph DJ. The surgical treatment of Peyronie's disease. Eur Urol 2006; 50:196.
- Kendirci M, Hellstrom WJ. Critical analysis of surgery for Peyronie's disease. Curr Opin Urol 2004; 14:381.
- Breyer BN, Brant WO, Garcia MM, et al. Complications of porcine small intestine submucosa graft for Peyronie's disease. J Urol 2007; 177:589.
- Knoll LD. Use of porcine small intestinal submucosal graft in the surgical management of Peyronie's disease. Urology 2001; 57:753.
- Kadioglu A, Sanli O, Akman T, et al. Graft materials in Peyronie's disease surgery: a comprehensive review. J Sex Med 2007; 4:581.
- Montorsi F, Guazzoni G, Bergamaschi F, Rigatti P. Patient-partner satisfaction with semirigid penile prostheses for Peyronie's disease: a 5-year followup study. J Urol 1993; 150:1819.
- Wilson SK, Delk JR 2nd. A new treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol 1994; 152:1121.
- Rahman NU, Carrion RE, Bochinski D, Lue TF. Combined penile plication surgery and insertion of penile prosthesis for severe penile curvature and erectile dysfunction. J Urol 2004; 171:2346.
- Montorsi, F, Salonia, S. Five year follow-up of plaque incision and vein grafting for Peyronie's disease. Eur Urol 2004; 3:33.
- Montorsi F, Salonia A, Maga T, et al. Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease. J Urol 2000; 163:1704.
- El-Sakka AI, Rashwan HM, Lue TF. Venous patch graft for Peyronie's disease. Part II: outcome analysis. J Urol 1998; 160:2050.
- Usta MF, Bivalacqua TJ, Sanabria J, et al. Patient and partner satisfaction and long-term results after surgical treatment for Peyronie's disease. Urology 2003; 62:105.
- Gholami SS, Gonzalez-Cadavid NF, Lin CS, et al. Peyronie's disease: a review. J Urol 2003; 169:1234.
- Licht MR, Lewis RW. Modified Nesbit procedure for the treatment of Peyronie's disease: a comparative outcome analysis. J Urol 1997; 158:460.
- Levine LA, Estrada CR. Human cadaveric pericardial graft for the surgical correction of Peyronie's disease. J Urol 2003; 170:2359.
- Akkus E, Ozkara H, Alici B, et al. Incision and venous patch graft in the surgical treatment of penile curvature in Peyronie's disease. Eur Urol 2001; 40:531.
- Wilson SK, Cleves MA, Delk JR 2nd. Long-term followup of treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol 2001; 165:825.
- 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