Contemporary surgical and non-surgical management of Peyronie's disease

Abstract

Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.

Keywords: Peyronie’s disease (PD); collagenase clostridium hystolyticum (CCH); grafting, penile prosthesis; penile plication; plaque excision; plaque incision.

Figure 1

Challenging cases amenable to plication. (A) Multiplanar curvature caused by Peyronie’s disease; (B) severe dorsal curvature in excess of 90 degrees. Both men were treated successfully with plication sutures placed to the convex aspects of each curve. Images courtesy of Allen Morey, MD.

Figure 2

Examples of plication sutures. (A) Imbrication suture as described by Essed and Schroeder; (B) Kiel’s Knot modification, wherein knots are directed under a partial-thickness flap of tunica albuginea, thereby addressing concerns of palpable suture knots. Illustration B courtesy of Daniar Osmonov, MD, PhD.

Figure 3

The minimally invasive technique is demonstrated. (A) Erection is induced at the start of the procedure and suture positions are planned; (B) 2–3 cm incisions are made near the base of the penis and retracted as needed to expose tunica for placement of plication sutures; (C) the straightened phallus is re-examined and further plication sutures are considered.

Figure 4

The double dorsoventral sliding technique is pictured. (A) The tunica albuginea is exposed by dissection through a circumcising incision; (B) after mobilizing the neurovascular bundles and the urethra, the corpora is transected in a stair-shaped fashion; (C) the staggered edges slide over a prosthesis cylinder and are sutured in place with grafted material filling the remaining gaps.