The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie's disease

Abstract

Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVE To assess plaque incision and venous grafting (the Lue procedure) to correct the deformity associated with Peyronie's disease and to maintain penile length, evaluating the results over an 8‐year period. PATIENTS AND METHODS The penile deformity of 113 patients (mean age 45 years, range 17–71) with Peyronie's disease was corrected by plaque incision and saphenous vein grafting. All patients had stable Peyronie's disease and had a mean (range) penile deformity of 64.5 (20–180)°; the mean follow‐up was 12 months. RESULTS The result was excellent or satisfactory in 105 patients (93%), and the penis completely straightened in 97 (86%). Erectile dysfunction after surgery developed in 10 of 68 potent patients (15%) although they had arterial risk factors of diabetes, hypertension or cardiac disease that may also have contributed. There was penile shortening of >1 cm in 29 men (25%) but this only prevented intercourse in two. Of the 51 patients with ≥ 5 years of follow‐up, the penis remained completely straight in 80% but the incidence of erectile dysfunction increased to 22.5% and penile shortening of >1 cm to 35%. CONCLUSION The Lue procedure is an effective long‐term option in the surgical management of Peyronie's disease, but penile shortening after surgery remains a risk, and patients with vascular risk factors must be warned of the possibility of later erectile dysfunction.

Peyronie’s surgery: Graft choices and outcomes

“…The authors concluded that plaque incision and vein grafting was associated with long-term patient dissatisfaction. The outcomes of this study were comparable to a report by Kalsi et al [25], in which 22.5% of patients had postoperative ED.…”

“…Complications from saphenous vein harvesting have been documented, including leg wound infection (2%), prolonged lymphatic leakage (2%), lymphocele (1%), and thigh wound hypoesthesia (1%) [14,25]. Because of the limitation of vein graft tissue, more than one incision may be necessary to cover a larger or more complex deformity.…”

Penile shortening after radical prostatectomy and Peyronie’s surgery

“…The Nesbit operation was fi rst used for PD in 1977 and is still the most common operation performed worldwide to correct penile curvature [29]. PD surgery has been associated with penile shortening, occurring in 7.3% to 90% of patients [30][31][32]. The amount of shortening also varies and has been reported to be as much as 5 cm [30].…”

A Reappraisal of Saphenous Vein Grafting

“…The technique involves an H-shaped tunical incision to release the contracture followed by defect repair with the use of an assembled SVG segments 113. Clinical investigations have shown that an excellent or satisfactory result was obtained in 92% to 93% of patients,114115 and the penis was completely straightened in 82% to 96% at a mean follow-up of 12-18 months 112115116. The application of a W-shaped SVG, which was molded according to the tunica defect, was associated with a straightened penis in 87.5% of the patients at a mean follow-up of 13 months 117.…”