Surgery for PD is currently only indicated in the chronic, stable state of the disease in patients with a degree of curvature that does not allow for sexual intercourse and/or causes pain, the study's authors pointed out.
Positive results reported from surgical series usually originate from relatively short follow-up periods. In part, this is due to the fact that patients who undergo reconstructive procedures tend to get lost for longer follow-up, said first author Florian Wimpissinger, MD, of the department of urology at Rudolfstiftung Hospital in Vienna, Austria.
Dr. Wimpissinger and colleagues followed 38 patients for a mean of 9.3 years (±5.2 years). All patients included in the retrospective study were operated on for chronic stable PD using plaque incision and grafting with autologous vein patches (dorsal vein of penis or saphenous vein).
"We saw that results tend to worsen with time," said Dr. Wimpissinger, who presented the study results at the 2011 European Association of Urology annual congress in Vienna.
Compared to past studies, Dr. Wimpissinger and colleagues concluded that, with longer follow-up, an increasing number of patients have recurrent curvature, erectile dysfunction, and shortening of the penis.
"Since these results were much better during the first months or few years following surgery, it can be assumed that all these aspects are caused by the chronic/recurring nature of PD," Dr. Wimpissinger said.
Rises in curvature, ED noted
After a mean of 9.3 years, the recurrence of postoperative curvature had increased from 0% after a mean of 38 months (18–73 months) to 23.7%, post-op erectile dysfunction increased from 3.0% to 39.5%, penile shortening from 0.0% to 65.8%, and impairment of penile sensitivity from 3% to 31.4%.
"From what we found after many years of follow-up, all published data on the results of PD surgery have to be interpreted in a different light," said Dr. Wimpissinger.
Timing of surgery in PD patients is defined as the stable state of disease with significant curvature due to plaque formation. Is it possible to operate on patients earlier than that?
"No, it is not possible to treat patients 'earlier' (eg, during the active painful phase)," Dr. Wimpissinger said. "By the time surgery is scheduled, we assume that the disease stands still. There are no indicators as to whether a patient will have 'reactivation' of PD later on in life."