Surgical outcomes from limiting the use of nonabsorbable suture in tunica albuginea plication for Peyronie’s disease

Abstract

Tunica albuginea plication (TAP) surgery for Peyronie's disease (PD) is classically described using nonabsorbable suture. Many patients are aware of nodularity at the suture sites (50-88%), and some find them painful (10-33%). We explore whether limiting permanent sutures provides a durable correction of curve and report the incidence of bothersome nodules. Beginning in 2007, we modified our TAP procedure to limit the use of permanent sutures. We reviewed all patients who underwent TAP procedures from 2007 to 2014 at our institution. Patients were contacted to complete a previously published survey regarding postoperative satisfaction. In total, 142 PD patients underwent the TAP procedure and 81/142 (57%) completed the postoperative survey. Mean office follow-up and survey follow-up were 17.3 and 56.3 months, respectively. Of the surveyed patients, 6.2% complained of a bothersome residual curve, 19.8% experienced nodularity and 4.9% reported bothersome nodules. Men with dorsal curves experienced less painful nodularity than those with ventral (P=0.047) or lateral curves (P=0.017). In total, 4/142 (2.8%) of men underwent repeat intervention. At long-term follow-up, limiting permanent sutures during TAP procedures for PD is durable with respect to curvature correction and has encouragingly low levels of nodularity and bother at suture sites.

The Rising Incidence of Penile Prosthesis Surgery as the First Line Surgical Treatment for Peyronie's Disease

“…16 It is highly effective at correcting most penile curvatures <60°, with reports of successful straightening ranging from 79%–100%. 16–18 Penile grafting has similar outcomes, with most studies reporting a success rate of >80%. 19 Among those without ED, plication and/or grafting results in penile straightening in 90%–100% of cases.…”

“…19,21 Penile grafting, even when performed at high volume centers or by experienced single surgeons, can result in significant penile sensory loss (up to 25%), hematoma (up to 26%), and veno-occlusive ED (variable results, up to 40%). 22 While the overall satisfaction scores for these procedures are variable, ranging from 65%–100% for plication 16–18 and from 41%–96% for grafting, 23 up to 80% of patients who undergo prosthesis insertion for the treatment of PD with concomitant ED are satisfied with their procedure, according to data from the PROSPER study. 24 Therefore, it is plausible that patients are choosing penile prosthesis surgery over alternative surgical options because of concern regarding adverse events or anticipated post-procedural dissatisfaction, regardless of erectile functional status.…”

Peyronie’s disease: Contemporary evaluation and management

“…Successful straightening postoperatively ranges 29–100% with overall patient satisfaction ranging 65–96% 35 . Palpable knots are reported in 50–100% of procedures, but significant bother associated with this palpability is substantially lower, ranging 0–20% 35,93,103 . Some authors have also reported satisfactory success rates with absorbable sutures to further minimize knot palpability while maintaining adequate straightening 14,105 …”

“…In fact, the best predictor of postoperative erectile function is strong and reliable preoperative erections 127 . Ventral graft placement, which requires urethral mobilization, has also been suggested as an independent risk factor for postoperative ED 13,110 . Therefore, in the setting of severe ventral curvature, where plication alone is unlikely to result in satisfactory curvature correction, penile prosthesis placement with concurrent straightening maneuvers should be strongly considered.…”

Letter: Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie's Disease: A Randomized Trial

“…The choice of permanent sutures for plication may also contribute to patient complaints of palpable lumps which can be minimized using few to no permanent sutures. 2…”