Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease

Francesco Montorsi, Andrea Salonia, Tommaso Maga, Lina Bua, Giorgio Guazzoni, Luigi Barbieri, Guido Barbagli, Roberto Chiesa, Giuliano Pizzini, Patrizio Rigatti

Research output: Contribution to journalArticle

Abstract

Purpose: We assessed the long-term outcome of plaque incision and vein grafting in select patients with Peyronie's disease by extensive preoperative and postoperative subjective and objective analysis. Materials and Methods: From January 1995 to June 1998, 50 men 28 to 62 years old (mean age 44) underwent surgery. Patients were evaluated preoperatively, 3 months after surgery and at a mean long-term followup of 32 months by sexual history, physical examination, determination of penile length and degree of curvature, dynamic color power Doppler sonography of the penile vessels and nocturnal RigiScan* evaluation for 3 nights. Study inclusion criteria were penile curvature 45 degrees or greater that made vaginal intromission impossible, stable disease for at least 6 months, patient reported normal penile rigidity, normal penile hemodynamics on color power Doppler ultrasound, normal nocturnal penile rigidity with at least 1 erection nightly (including base and tip rigidity greater than 60%, and a duration of 10 minutes) and absent base-tip discrepancies. Plaque was usually approached via a combined subcoronal and midline sagittal scrotal incision. Maximal rigidity was created intraoperatively and 1 to 3 plaque incisions were made. Saphenous vein patches were then grafted at the incision sites. Postoperatively patients were systemically treated with neurotrophic factors and low molecular weight heparin. Local vacuum supported corporeal stretching was done and weekly alprostadil injections were given to optimize corporeal oxygenation. Results: At long-term followup complete penile straightening was achieved in 40 cases (80%), minor residual curvature of 30 degrees or less persisted in 7 (14%) and significant disease recurred in 3 (6%). Penile rigidity was equal to that preoperatively in 47 patients (94%), while 3 (6%) reported clinically significant decreased potency. Penile length was equal to that preoperatively in 30 patients (60%), while 20 (40%) noticed slight penile shortening. Postoperatively penile color power Doppler sonography showed vascular impairment in 5 men (10%) and nocturnal RigiScan testing revealed a significant decrease in nightly erections in 5 (10%). Surgical complications included penile hypoesthesia in 1 case (2%), penile hematoma in 2 (4%), wound infection in 1 (2%) and glandular ischemia in 1 (2%). Conclusions: Plaque incision and vein grafting achieved satisfactory clinical results in the majority of patients with severe and stable Peyronie's disease, intact penile rigidity preoperatively, normal penile color power Doppler ultrasound and normal nocturnal RigiScan testing.

Original languageEnglish
Pages (from-to)1704-1708
Number of pages5
JournalJournal of Urology
Volume163
Issue number6
Publication statusPublished - Jun 2000

Keywords

  • Graft
  • Penile induration
  • Penis
  • Saphenous vein

ASJC Scopus subject areas

  • Urology

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    Montorsi, F., Salonia, A., Maga, T., Bua, L., Guazzoni, G., Barbieri, L., Barbagli, G., Chiesa, R., Pizzini, G., & Rigatti, P. (2000). Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease. Journal of Urology, 163(6), 1704-1708.