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

Purpose: We assessed the long-term outcome of plaque incision and vein graf ting in select patients with Peyronie's disease by extensive preoperative a nd postoperative subjective and objective analysis. Materials and Methods: From January 1995 to June 1998, 50 men 28 to 62 year s old (mean age 44) underwent surgery. Patients were evaluated preoperative ly, 3 months after surgery and at a mean long-term followup of 32 months by sexual history, physical examination, determination of penile length and d egree of curvature, dynamic color power Doppler sonography of the penile ve ssels and nocturnal RigiScan* evaluation for 3 nights. Study inclusion crit eria were penile curvature 45 degrees or greater that made vaginal intromis sion impossible, stable disease for at least 6 months, patient reported nor mal penile rigidity, normal penile hemodynamics on color power Doppler ultr asound, normal nocturnal penile rigidity with at least 1 erection nightly ( including base and tip rigidity greater than 60%, and a duration of 10 minu tes) and absent base-tip discrepancies. Plaque was usually approached via a combined subcoronal and midline sagittal scrotal incision. Maximal rigidit y was created intraoperatively and 1 to 3 plaque incisions were made. Saphe nous vein patches were then grafted at the incision sites. Postoperatively patients were systemically treated with neurotrophic factors and low molecu lar weight heparin. Local vacuum supported corporeal stretching was done an d weekly alprostadil injections were given to optimize corporeal oxygenatio n. Results: At long-term followup complete penile straightening was achieved i n 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 cl inically significant decreased potency. Penile length was equal to that pre operatively in 30 patients (60%), while 20 (40%) noticed slight penile shor tening. Postoperatively penile color power Doppler sonography showed vascul ar impairment in 5 men (10%) and nocturnal RigiScan testing revealed a sign ificant decrease in nightly erections in 5 (10%). Surgical complications in cluded 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 clinic al results in the majority of patients with severe and stable Peyronie's di sease, intact penile rigidity preoperatively, normal penile color power Dop pler ultrasound and normal nocturnal RigiScan testing.