V.P. Stus, A.L. Suvarian

Modern tactics of treating patients with Peyronie’s disease

Peyronie’s disease (PD) or fibroplastic induction of the penis has a negative effect on the quality of life of patients due to fibrous damage to the protein coat of the cavernous bodies, leading to curvature of the penis, development of erectile dysfunction, depressive symptoms in the patient, and psycho-sexual disorders in sexual couples.

In the treatment of PD, conservative and surgical methods are used. Due to the lack of clear understanding of the etiology and pathogenesis of PD, there are no sufficiently effective drugs for conservative therapy. The main treatment for Peyronie’s disease is surgical.

From 2006 to 2019, at the Urology Clinic of the Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov treated 114 patients with Peyronie’s disease aged 23 to 78 years (cf. 43.16 ± 28.46). Of these, 47 patients (41.23%) underwent conservative treatment, and 67 patients (58.77%) underwent surgical treatment. Out of 61 patients: 8 patients (13.11%) used plication surgery: Nesbit-Shcheplev operation to 2 patients (3.28%), Essed-Schroder operation to 6 patients (9.84%); 21 patients (34.43%); corporoplasty was performed with preserved erectile function using a section of the wide femoral fascia (ZKPSHFB), and 31 patients (40.98%) had a vaginal membrane of the testicle (ZKVOYA). Endofalloprosthetics were performed in 8 patients (11.94%) with severe erectile dysfunction.

After conservative therapy, the pain syndrome was stopped in all patients 47 (100%), stabilization of the curvature was achieved in 43 (91.49%) patients, a decrease in the angle of curvature (up to 15°) in 11 patients (23.40%), and a reduction in the volume of the plaque in 12 patients (25.53%), improved erectile function in 35 patients (92.10%) (IIEF before treatment 18.4 ± 1.5 points, after treatment 23.6 ± 1.2 points). Resorption of the plaque was not observed in anyone.

After plication operations, the patient achieved straightening of the penis, without significant loss of penile length. In 1 patient (12.5%), a decrease in the sensitivity of the glans penis was observed, which is within 3 months. fully restored. Subcutaneous hematomas of the penis that do not require additional surgical procedures were noted in 4 patients: (50%). Erectile dysfunction was noted in 1 patient with impaired sensitivity of the head (12.5%), which was corrected by additional conservative therapy.

All patients who underwent replacement corporoplasty with a section of the wide fascia of the femur achieved correction of penile deformity without shortening the size of the penis and restoration of copulative function. Only 3 patients (14.3%) retained residual curvature of the penis (less than 10Ъ), which did not interfere with sexual intercourse. In the early postoperative period, 8 patients (13.11%) showed a decrease in the sensitivity of the glans penis, and 5 (19.04%) for 3 months. sensitivity was fully restored, in 2 (3.28%) complaints remained. Subcutaneous hematomas of the penis that do not require additional surgical interventions were noted in 11 patients: (18.03%). Erectile dysfunction was noted by 2 (9.52%) patients, which was corrected by additional conservative therapy. Graft retraction was noted in 2 (9.52%), due to the fact that these patients did not undergo postoperative rehabilitation.

In case of cororoplasty with a transplant of the vaginal sheath of the testis (ZKVOY), only 4 patients (12.90%) retained residual curvature of the penis (less than 10Ъ), which did not interfere with sexual intercourse. In the early postoperative period, 9 (29%) showed a decrease in the sensitivity of the glans penis, and 6 (19.35%) for 3 months. sensitivity was fully restored, in 3 (9.67%) complaints remained. Subcutaneous hematomas of the penis that do not require additional surgical interventions were noted in 9 (29%). Erectile dysfunction was noted by 6 patients (19.35%), which was corrected by additional conservative therapy. In 1 (3.22%) patient, due to recurrence of the disease and worsening erection, endofalloprosthetics were performed in a year. In 1 patient (3.22%), deformation of the foreskin was noted. After 2 months, circumcisio was given to this patient. Graft retraction was noted in 5 (16.1%). However, in these patients, the residual curvature was less than 30 °, which did not interfere with sexual activity.

Findings. Thus, the effectiveness of conservative therapy remains low. But it is necessary in order to stabilize the inflammatory process, relieve pain, improve and maintain erectile function.

Surgical treatment is a highly effective method and leads in 100% of cases to the restoration of the patient’s copulative function.