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[Surgical treatment of La Peyronie's disease].

Lapeyronie disease is responsible for curvature of the penis, making sexual intercourse painful or even impossible. Surgical treatment can be proposed when the plaque has remained stable for at least 6 months and after failure of medical treatment. It is designed to restore erection allowing penetration. Examination after an intracavernous test allows assessment of the deformity and the quality of erection. These two objective parameters appear to be decisive in the choice of the most appropriate technique. Two types of methods are available: cavernoplasties (resection-plication of the tunica albuginea, excision-graft) and prosthesis implantations (semirigid, inflatable and flexible implants). This paper reviews the various surgical techniques and proposes a decisional flow-chart based on the results of the intracavernous test.

Humans↗

Long-term experience with the AMS 700CX inflatable penile prosthesis in the treatment of Peyronie's disease.

The objective of this article is to evaluate the long-term success and complication rates for the surgical implantation of the American Medical Systems (AMS) 700CX penile prosthesis for the treatment of Peyronie's disease in a relatively large patient population. For a period of 8 years, between 1986 and 1994, severe Peyronie's disease was diagnosed in 309 men who elected to have prosthetic surgery performed and who had no history of prior prosthetic surgery. All patients were treated by surgical placement of an inflatable prosthesis, using the AMS model 700 CX. All surgical approaches were scrotal. Surgical and demographic data were collected on the day of surgery, and follow-up data were obtained from chart review and telephone interview. Descriptive statistics were utilized to obtain results. A surgical success rate of 98.4% was achieved for primary implants, as assessed by the number patients who did not required further surgical intervention, during the mean follow-up period of 3.5 years. Only 5 patients (1.6%) required revision surgery. In the 304 patients who retained a primary prothesis implant, sexual intercourse was possible for all patients within 6-8 weeks. Mean patient age at surgery was 56.5 years. Primary diagnosis was Peyronie's disease in 73% of the patients; the other 27% of patients had Peyronie's disease secondary to a primary diagnoses of either diabetes mellitus (17%), organic/idiopathic disease (8%), or other etiologies (2%). The results suggest that the surgical implantation of the newer model prosthesis as a treatment for Peyronie's disease offers a highly successful therapy with low morbidity.

Adult↗

[Correction of acquired penile curvatures].

Penile acquired curvatures are related to the effects of the evolution of Peyronie's disease or to the results of conservative treatments. All the others (post-traumatic, post surgical) are quite rare and often therapeutically similar. More than 50% of penile acquired curvatures can today take advantage from pharmacophysical managements thanks to the technological progresses of industry and of the personal experience (cavernopharmacoperfusion) both being clinically suitable application for the effective results: more than 60% of stop in progression with decrease of the recurvatum enough to resume comfortable sexual intercourse. Last, when erectile failure is present, we suggest prosthesis implant preferring flexible-malleable device such as AMS 600. More recently we started an effective experience with the new silicone elastomers of Subrini (Virilis II). Both implants never required complementary surgery of the plaque to achieve straightening and sexual activity of satisfactory level.

Calcinosis↗

[Surgical therapy of penis shaft induration in congenital penis deviation and induratio penis plastica].

The therapy of Peyronie's disease is an operative one primarily. Indication for the operative treatment is the penile deviation which prevents the patient from intercourse. The method of choice is plaque excision and subsequent corporoplasty with dermal graft. Good long-term results can also be achieved with a sole straightening of the penile shaft without plaque excision. However, this procedure (Nesbit's operation) results in a shortening of the length. In patients who are suffering from an additional erectile dysfunction an implantation of a penile prosthesis is done accompanied by plaque excision and a corporoplasty with alloplastic material (Dacron, Goretex). In 80% of all cases good postoperative results can be achieved with the operative treatment of Peyronie's disease. Patient's satisfaction is very good with all procedures described above. The exact diagnosis of the erectile quality seems to have a prognostic value for the postoperative result.

Erectile Dysfunction↗