IPP and Penile Curvature Decisions: Doing Nothing, Something or Everything
Jay Simhan, MD, FACS, examines the challenges of penile implants in patients with refractory erectile dysfunction and Peyronie’s disease.
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Topic: Peyronie’s Disease
Peyronie’s Disease Surgery: Considerations, Tips, and Pitfalls
William O. Brant, MD, FACS, FECSM, explores surgical approaches for Peyronie’s disease, focusing on penile curvature correction.
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Management of Peyronie’s Disease
Ayman Soubra, MD, addresses the treatment of Peyronie’s disease. In this 24-minute presentation, he begins by reviewing the condition, its pathophysiology, and its prevalence. Dr. Soubra also discusses the evaluation of Peyronie’s disease, including a thorough medical history, examination for familial traits (such as Dupuytren’s contractures), and physical examination.
Several treatment options exist, from noninvasive oral and topical therapies to mechanical therapies like vacuum and traction devices. Dr. Soubra discusses intralesional collagenase injections at length. This therapy is FDA-approved based on clinical trials and significantly improves penile curvature. For severe cases, surgical options such as tunical plication or grafting may be necessary, especially for patients with significant deformities or erectile dysfunction. Soubra shares indications and techniques for this procedure in detail.
Dr. Soubra recommends multimodal approaches tailored to the patient’s specific goals and severity of symptoms.
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Peyronie’s Disease: Surgical Approaches
William O. Brant, MD, FACS, FECSM, Urologist at the Veterans Affairs Medical Center in Salt Lake City, Utah, presents an analysis of surgical approaches for Peyronie’s disease. With a focus on both shortening and lengthening procedures, Dr. Brant delves into the intricacies of various surgical techniques, providing a thorough examination of each method’s benefits and considerations. In his meticulous exploration, Dr. Brant begins by discussing the placation technique, a procedure aimed at addressing the excessive curvature caused by Peyronie’s disease. He elucidates the surgical process, highlighting its potential for restoring penile function and improving patient satisfaction. Furthermore, Dr. Brant explores the outcomes of placation, including changes in penile length and erectile function, enabling readers to grasp the potential benefits and limitations associated with this approach. Moving forward, the discussion expands to encompass plaque incision and excision techniques, which involve the precise removal of the fibrous plaque responsible for the curvature. Beyond the technical aspects, Dr. Brant also emphasizes the importance of personalized decision-making in the management of Peyronie’s disease. He discusses the significance of considering individual patient needs, taking into account factors such as disease severity, patient preferences, and overall health. The presentation encompasses an array of clinical scenarios and surgical techniques, showcasing Dr. Brant’s wealth of experience and expertise in the field. From the assessment of deformities to the exploration of different incision options, the presentation offers a comprehensive overview of the surgical approaches available for Peyronie’s disease.
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Off-Label Use of Xiaflex for Peyronie’s Disease
Jesse N. Mills, MD, Associate Clinical Professor and Director of the Men’s Clinic at UCLA, discusses techniques for Xiaflex on and off label, and when and how it can be used to treat Peyronie’s disease. These include alternative injection techniques, plaques involving the penile urethra, use for men on anticoagulation treatments, and non-goniometric deformity.
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New Paradigm for the Treatment of Peyronie’s Disease
Culley C. Carson III, MD, Professor Emeritus at the University of North Carolina School of Medicine, reviews the history of treatment options for Peyronie’s Disease. He then compares clinical results of oral therapies, injection techniques, shock wave therapy, and penile prosthesis. Since first being developed, the efficacy of several of these protocols has improved and patients have experienced a reduction in curvature. Patients with Peyronie’s Disease often report significant negative emotional toll as a result of the condition, and new advances in treatment, such as the combination of drug and lengthening device that improves penile angulation can also improve depression and emotional problems.
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