Atlanta-Which procedure nets better results for patients with Peyronie's disease-corporeal plication or plaque incision with venous grafting? According to a long-term study from Kaiser Permanente Medical Center in Los Angeles, there is no difference between the two procedures in terms of patient satisfaction. The major difference between the two is time spent in the operating room.
"The two procedures are nearly equivalent in their ability to correct penile deformity," said Sherif R. Aboseif, MD, director of neuro-urology and reconstructive surgery at Kaiser. "If there is no specific indication for the 4-hour [plaque incision and grafting] procedure, such as severe lateral indentation or bottleneck deformity, I would suggest plication because it offers the same results."
In the study comparing the two procedures that he presented here at the AUA annual meeting, Dr. Aboseif reported that the corporeal plication with plaque incision procedure took a mean OR time of 65 minutes compared with a mean of 200 minutes for the plaque incision and graft.
He added that another factor to be considered when discussing the two surgical options was that the incision and graft procedure appears to carry the greater risk of diminished sensation, decreased rigidity, and erectile dysfunction.
Patients informed of risks
To arrive at these conclusions, Dr. Aboseif and his colleagues identified 42 patients with penile deformity secondary to Peyronie's disease. Those patients with severe pain or severe erectile dysfunction unresponsive to oral or injected medical therapies were excluded from the study. Patients were evaluated with Doppler ultrasound following injection of a vasoactive agent.
The patients chose a procedure after detailed consultation about the nature of each procedure. One essential aspect of this consultation is informing the patients of the effects of both procedures on penile length.
"I usually tell them that any surgical procedure to correct a penile deformity may result in some shortening," Dr. Aboseif said. "We really don't know whether it is the surgical procedure that results in the shortening or it is a result of the pathology of the Peyronie's. So I tell my patients that either procedure may result in shortening over time."
Following the presentation of this and several other studies about Peyronie's disease, researchers discussed whether the procedures reduced penile length. The consensus appeared to be that all patients should be told that shortening was a possible outcome regardless of the procedure chosen.
Plication was performed on 18 patients, and the incision with graft procedure was performed on 24 patients. At 1-year follow-up, the patients were interviewed by telephone, with 16 in the plication group and 20 in the incision group responding. In the plication group, 13 (81%) said they were satisfied and had noted no change in the quality of their erections compared with 14 (70%) of the patients in the incision group.
In the plication group, one patient complained of persistent pain at the site of the sutures, and two said they had a shortening of the penis sufficient to impair intercourse. In the incision group, two said they had persistent curvature, and four said they had poor erections owing to a decrease in rigidity. Six of the incision patients complained of penis shortening, but only three said it was a significant bother.
The study's authors concluded that both procedures are effective, but that penile plication was a simpler procedure with similar outcomes but fewer complications than plaque incision with venous graft.