Erectile Dysfunction after Plaque Incision and Grafting: Short-term Assessment of Incidence and Predictors

Abstract

Introduction Plaque incision and grafting (PIG) surgery for Peyronie's disease (PD) is a recognized management strategy. One of the recognized complications of PIG surgery is the development of postoperative erectile dysfunction (ED). Aim To determine the incidence of ED after PIG surgery and attempt to define predictors of ED development. Methods All patients underwent preoperative cavernosometry. Grafting was performed with either cadaveric pericardium (Tutoplast) or intestinal submucosa (Surgisis). Prior to 2006, the procedure used an H-type incision, whereas after this date, the Egydio approach has been used. Main Outcome Measures Men undergoing PIG completed preoperative and 6-month postoperative International Index of Erectile Function (IIEF) questionnaires. Results 56 patients were analyzed. Mean patient and partner ages were 57 ± 22 and 54 ± 18 years, respectively. Mean duration of PD at the time of PIG was 22 ± 9 months. Seventy-five percent had curvature alone, 11% had hourglass/indentation deformity, and the remainder had combined curvature/indentation. Mean preoperative curvature was 52 ± 23°. Fifty-two had grafting with Tutoplast, while four had grafting with Surgisis. All men at baseline were capable of generating a penetration rigidity erection. Preoperatively, 50% of men had cavernosal insufficiency and 21% had venous leak (baseline and postoperative erectile function [EF] domain scores were 23 ± 4 and 17 ± 9, respectively [P < 0.01]). Forty-six percent of men experienced a ≥6-point decrease in EF domain score after PIG. The predictors of a ≥6-point reduction in IIEF-EF domain score on multivariable analysis were degree of preoperative curvature, type of plaque incision, patient age, and baseline venous leak. Conclusions Almost one-half of men had significant reduction in their erectile rigidity after PIG. Reduction was predicted by larger baseline curvature, the Egydio plaque incision technique, older patient age, and the presence of venous leak at baseline. Based on these data, we discourage older men, those with venous leak, and those with profound curvature from considering PIG surgery.

Surgery for Peyronie's disease

“…These men should have strong sexually induced rigidity to reduce the likelihood of postoperative ED. 26,27 (Box 3).…”

“…27,38,39 These predictors have been suggested as a result of single-center studies with a limited number of patients in each cohort. Larger scale studies indicate that the most critical criterion for any grafting procedure appears to be the quality of their preoperative erections.…”

“…Larger scale studies indicate that the most critical criterion for any grafting procedure appears to be the quality of their preoperative erections. 26,27,39 Surgical grafting techniques include plaque incision or partial plaque excision. Historically, total excision of the plaque was practiced to 'cut out the disease', resulting in onlays of large grafts with an unacceptably high rate of ED.…”

“…42 Geometrical principles have been applied to the grafting technique in an effort to obtain a reliably sized graft, this approach appears unnecessarily complex and there have been reports of a higher rate of ED when this technique is used. 27,43 Egydio et al 44 reported the results of the incomplete circumferential incision of a penile plaque and the use of a bovine pericardial graft. The authors achieved an 88% rate of penile correction in 33 PD patients, with a mean increase of 2.21 cm in penile length.…”

Recent surgical advances in Peyronie’s Disease

“…Factors associated with post-operative ED are pre-operative ED, age (> 55 years), curvature > 60º, preoperative venous leak. 17 …”