Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function

Chung, Eric

doi:10.5534/wjmh.170056

Cited by 26 publications

(45 citation statements)

References 56 publications

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“…All cases were mild and treated with NSAIDs. These results were comparable with those of previous studies [7,10,11,15], and both fillers seemed safer than surgery [14,21,22].…”

Section: Discussionsupporting

confidence: 91%

Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections for Penile Augmentation in Men Reporting a Small Penis: A Multicenter, Patient-Blinded/Evaluator-Blinded, Non-Inferiority, Randomized Comparative Trial with 18 Months of Follow-up

Yang

Jeong

et al. 2020

JCM

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Although several types of penile augmentation (PA) fillers have been recently introduced, no long-term follow-up studies have compared them. This study aimed to compare the long-term clinical outcomes of hyaluronic acid (HA) and polylactic acid (PLA) filler injections for PA. Our multicenter, patient-blinded/evaluator-blinded, randomized comparative trial was performed for 18 months after the single injection of fillers. Sixty-seven healthy men reporting a small penis were administered an injection between November 2016 and May 2017. Subjects were divided into the HA group (n = 33) and PLA group (n = 34). At 18 months, the mean penile girths had significantly increased in both groups (each p < 0.001). Changes in the mean penile girth of both groups were not significantly different during the study period. Satisfaction levels at 18 months were significantly higher than those at baseline in both groups (each p < 0.01). Changes in satisfaction levels did not differ significantly during the study period. Injection-associated adverse events (AEs) occurred in three (9.1%) patients in the HA group and in two (5.9%) patients in the PLA group; no serious AEs occurred. In conclusion, HA and PLA filler injections for PA led to significant augmentation and increased satisfaction. Clinical efficacy and safety were comparable between groups.

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“…All cases were mild and treated with NSAIDs. These results were comparable with those of previous studies [7,10,11,15], and both fillers seemed safer than surgery [14,21,22].…”

Section: Discussionsupporting

confidence: 91%

Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections for Penile Augmentation in Men Reporting a Small Penis: A Multicenter, Patient-Blinded/Evaluator-Blinded, Non-Inferiority, Randomized Comparative Trial with 18 Months of Follow-up

Yang

Jeong

et al. 2020

JCM

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“…Numerous literature has described techniques for penile plication and their efficacy and safety profiles [7,8]. Recently, work has focused on minimally invasive approaches [9,10] and correction of more extensive curvatures (>60°) [5,11].…”

Section: Discussionmentioning

confidence: 99%

Scrotal septum detachment during penile plication to compensate for loss of penile length compared with conventional surgical technique

et al. 2020

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Purpose: To evaluate the efficacy and safety of penile elongation featuring simple scrotal septum detachment from the penile base to compensate for the loss of penile length during penile plication in patients with Peyronie's disease compared with conventional penile plication. Materials and Methods: We conducted a retrospective analysis of 38 patients (24-75 years of age) with Peyronie's disease who underwent penile plication with or without our novel technique from January 2009 to May 2018. Penile elongation was achieved by release and detachment of the scrotal septum from the penile base to the level of the scrotal fat tissue. The objective outcome of change in stretched penile length (SPL) and the subjective outcome of patient perception of postoperative penile length were compared between groups. Any postoperative complications were recorded. Results: Of the 38 patients, 16 underwent penile plication with scrotal septum detachment (elongation group) and 22 underwent penile plication only (conventional group). The postoperative mean SPL was increased in the elongation group and decreased in the conventional group (1.2±1.3 cm vs.-0.5±0.3 cm, p<0.001). Fourteen of 16 patients (87.5%) in the elongation group reported perceived penile lengthening after surgery, whereas 17/22 patients (77.3%) in the conventional group complained of penile shortening. We encountered no procedure-related complications such as hematoma, infection, or necrosis in either group. Conclusions: Simple detachment of the scrotal septum from the penile base afforded both objective and subjective penile elongation without any severe complications compared with conventional penile plication.

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“…Plaque incision or partial excision is the preferred technique over plaque excision to minimize disruption of the underlying veno-occlusive mechanism [31]. While immediate postoperative length loss is minimal, long-term follow-up studies showed greater risks such as ED (up to 60%), length loss (~20%) and recurrence of curvature (20%) [1,32,33]. While the ideal graft material remains elusive, various autologous tissues such as dermis, vein or Tunical tissue, and allograft and xenograft materials such as pericardium, small intestinal submucosal and dermis, have been used with reasonable outcomes [32].…”

Section: Penile Reconstructive Surgery (Grade B Level 3)mentioning

confidence: 99%

“…Postoperative penile rehabilitation is advisable and often involves the use of oral phosphodiesterase type 5 inhibitors and/or penile traction therapy [1]. Complex penile reconstruction is a highly technical and demanding surgery and should be performed by surgeons with extensive prosthetic and reconstructive experience since the risk of sensory loss, glans ischaemia/ necrosis, ED and failure to gain any meaningful length are serious postoperative concerns that can be difficult to treat [33].…”

Section: Penile Reconstructive Surgery (Grade B Level 3)mentioning

confidence: 99%

“…The use of graft material is associated with a higher risk of prosthetic infection [1]. Novel surgical techniques to improve penile lengthening and girth at the time of penile prosthesis implantation using various modified sliding techniques [33] have been reported with high patient satisfaction rates and relatively small but serious complications such as glans necrosis and penile gangrene [36].…”

Section: Penile Reconstructive Surgery (Grade B Level 3)mentioning

confidence: 99%

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A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association

Chung

Gillman

Tuckey³

et al. 2020

BJU International

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Objective To provide a clinical framework and key guideline statements to assist clinicians in the evidence‐based management of Peyronie’s disease (PD). Methods We conducted a review of the published literature relevant to PD management, with an emphasis on published clinical guidelines. References used in the text have been assessed according to their level of evidence, and guideline recommendations have been graded based on the Oxford Centre for Evidence‐based Medicine Levels of Evidence. Results The management of PD involves taking a detailed penile and sexual history, with a focused penile examination to identify plaque and hourglass deformity, and digital photographs of the erect curved (deformed) penis. Penile colour Duplex ultrasonography evaluates tunical plaque and underlying cavernosal smooth muscle and blood flow variables. The current therapy for PD can be divided into two main groups, namely, medical therapy and penile reconstructive surgery, and the patient should be counselled on the benefits and risks of each treatment option. Conclusions Peyronie’s disease remains a clinical challenge and presents a considerable therapeutic dilemma as the current therapy addresses existing penile curvature only and is not very effective in preventing future penile fibrosis and/or reversing underlying erectile dysfunction.

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Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function

Abstract: While surgical approaches remain the standard of care, they pose considerable risks and require prolonged postoperative rehabilitation. Obtaining proper informed consent and establishing realistic outcome expectations are imperative for successful postoperative outcomes.

Cited by 26 publications

References 56 publications

Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections for Penile Augmentation in Men Reporting a Small Penis: A Multicenter, Patient-Blinded/Evaluator-Blinded, Non-Inferiority, Randomized Comparative Trial with 18 Months of Follow-up

Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections for Penile Augmentation in Men Reporting a Small Penis: A Multicenter, Patient-Blinded/Evaluator-Blinded, Non-Inferiority, Randomized Comparative Trial with 18 Months of Follow-up

Scrotal septum detachment during penile plication to compensate for loss of penile length compared with conventional surgical technique

A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association

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