3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 device with a shorter treatment regimen. Additionally, Wymer et al reported in a separate study that RestoreX PTT may offer a more cost-effective method for achieving ≥ 20% curvature improvement compared with surgery or CCh. 38 While PTT has shown positive results in the scientific literature with promising developments on the horizon, current AUAguidelines do not include its use in their recommendations. 10 Further studies should be performed exploring PTT on a larger scale. Surgical treatments Penile plication Historically, surgery has been considered the gold- standard treatment for PDwith relatively high success rates (65%-96% achieving penile straightening). 38 Tunical plication surgery involves the placement of sutures on the side opposite of the plaque to “pull” the penis into a straighter shape. The surgery may be offered to patients who have adequate penile rigidity for coitus (with or without pharmacotherapy and/or vacuum device therapy). Several studies have been performed demonstrating its safety and efficacy as a simple and straightforward surgery with minimal chance of inducing EDor decreased sensation. Surgical technique may vary depending on plaque location and may involve midline incision, circumcision incision, or penile degloving. Furthermore, surgical plication options include corporoplasty techniques (i.e. Nesbit, Yachia) and nonincisional techniques. Various modifications have been made over the years to improve outcomes and avoid adverse events. Gholami and Lue published their results using a 16- dot plication technique in 132 consecutive patients, which demonstrated excellent and durable results with 93% of patients reporting straight erections at 6 months postoperatively. 39 Other studies have also pushed the limits in plication techniques and understanding. Once reserved only for noncomplex small degrees of penile deformity, newer studies have demonstrated the efficacy of penile plication in more complex deformities as well as those of different curvature types (dorsal, ventral, lateral). Adibi et al published their results in 43 patients with complex penile deformity (11 biplanar curvature, 32 severe curvature ≥ 60°) treated with plication surgery. 40 Their study utilized a 2 cm penoscrotal incision mobilized distally along the penile shaft without degloving. In the 11 men with biplanar curvature, median angle in the primary plane of curvature improved from 45° to 10°, with the secondary plane corrected from 35° to 5° using an average of 7 sutures. Among the 35 patients with severe curvature, plication was able to correct the median angle from 70° to 15° using an average of 11 sutures. In a separate study comparing the safety and efficacy of patients undergoing penile plication for different types of curvature, Chung et al performed a retrospective review with outcome data in patients with dorsal, ventral, and lateral curvature. 41 The study demonstrated that penile plication was safe and effective for correcting all directions of PD curvature with patient-completed satisfaction surveys at a mean of 15 months demonstrating equally high rates of satisfaction for penile curvature, penile rigidity, strength of erection, and overall satisfaction. Data revealed a similar number of sutures required for each group (8-9) to achieve similar curvature correction (37°-45°). Decreased penile length was reported subjectively, however objective length loss was small (mean length loss for all groups, 0.3 cm-0.8 cm). These studies demonstrate that plication can be a safe and effective surgical treatment option for PD in dorsal, ventral, lateral, biplanar, and severe curvatures. Plaque incision or excisionwith or without grafting Plaque incision or excision with or without grafting is an alternative surgical technique which can be offered to patients with adequate rigidity for coitus (with or without pharmacotherapy and/or vacuum device therapy). This surgery may be most applicable to patients with severe deformities, significant hourglass deformities, or plaque burden. Plaque incision or excision comes with increased risks, with studies reporting complication rates as high as 67% for postoperative ED and 20% for decreased sensitivity. 42,43 Interestingly, while these surgeries often preserve penile length, rates of penile shortening have been reported to range from 18%to 43%. 43,44 Nevertheless, the surgery has demonstrated durable and effective results withWimpissinger et al reporting a 73%patient satisfaction rate with plaque incision and vein grafting at mean followup of 156 months. 43 Sansalone et al also demonstrated high patient satisfaction rates of 97% at mean followup of 20months following plaque incision and grafting with bovine pericardium in 157 men. 45 Grafting materials vary and include autografts, synthetic inert substances (e.g. Dacron, Gortex, silicone with silastic borders), allografts, xenografts, and collagen fleece. In a study comparing patient- perceived outcomes of plaque incisionwith saphenous vein grafting to corporeal plication, Kim et al reviewed the records of 67 patients at 1 year follow up. 46 Study results showed no differences between the two techniques regarding satisfactory straightness (p = 0.13), satisfaction with surgery (p = 0.71), Chung et al. 16