Download PDF
Aktuelle Urol 2001; 32(S1): 72-76
DOI: 10.1055/s-2001-15952
OPERATIVE THERAPIE
Georg Thieme Verlag Stuttgart · New York

Operative Therapie der Induratio penis plastica

Surgery of Induratio Penis PlasticaW. L. Strohmaier
  • Klinik für Urologie und Kinderurologie, Klinikum Coburg
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die operative Therapie der Induratio penis plastica ist keine kausale Therapie. Sie ist nur indiziert, wenn die Deviation die Kohabitation behindert, wenn erhebliche Schmerzen dabei bestehen oder eine anderweitig behandelbare erektile Dysfunktion vorliegt. Der Aufklärung des Patienten über das zu erwartende Ergebnis und mögliche Komplikationen ist außerordentlich wichtig. Wir können zwischen Plikatur- und in-/exzidierenden Verfahren mit plastischer Deckung und Methoden mit Penisprothesenimplantation unterscheiden. Bei den Plikaturverfahren sind Methoden mit Exzision eines Ellipsoids (z. B. Nesbit-OP) den Techniken ohne Ausschneidung (z. B. Essed-Schroeder) überlegen. Nachteil der Plikaturverfahren ist die Verkürzung des Penis. Bei den in-/exzidierenden Verfahren erfolgt die Defektdeckung entweder mit körpereigenen (z. B. Vene) oder Fremdmaterialien (z. B. TachoComb®). Eine eindeutige Überlegenheit eines bestimmten Verfahrens besteht dabei nicht. Folgende Resultate werden beschrieben: persistierende/rezidivierende Deviation 17 - 29 %, postoperative erektile Dysfunktion 0 - 33 %, Penisverkürzung 0 - 100 %, Zufriedenheit 50 - 85 %, Komplikationen 0 - 50 %. Die Indikation zur Penisprothesenimplantation besteht bei gleichzeitiger erektiler Dysfunktion (in der Regel veno-okklusiv). Welches Verfahren angewandt wird, sollte individuell von der jeweiligen Befundkonstellation und den Wünschen des Patienten abhängig gemacht werden.

Abstract

Surgery for Peyronie's disease is not a causal therapy. It is indicated in men with penile deviation impeding sexual intercourse, considerable pain during erection and concomitant erectile dysfunction. An adequate information and counseling of the patient on the nature of the disease, surgical results and possible complication is important. Plication procedures, incising/excising methods with grafting and methods with prosthesis implantation can be distinguished. Among plication procedures, those with corporoplasty (e. g. Nesbit operation) are superior to techniques without corporoplasty (e. g. Essed-Schroeder). In excising/incising procedures, autologous (e. g. vein patches, tunica vaginalis, dermal grafts) or synthetic materials (e. g. TachoComb®) are used for grafting. So far, there is no evidence that one of the materials is definitively superior. The following results were reported: persistent/recurrent deviation 17 - 29 %, postoperative erectile dysfunction 0 - 33 %, shortening of the penis 0 - 100 %, patient satisfaction 50 - 85 %, complications 0 - 50 %. The indication for implantation of a penile prosthesis is concomitant erectile dysfunction (i. e. veno-occlusive type). The proper selection of the adequate procedure is dependant on the individual findings and the patient's preference.

Schlüsselwörter:

Induratio penis plastica - Morbus Peyronie - Operative Technik - erektile Dysfunktion

Key words:

Induratio penis plastica - Peyronie's disease - Surgery - Surgical treatment

Literatur

  • 1 Essed E, Schroeder F H. New surgical treatment of Peyronie disease.  Urology. 1985;  25 580-582
    PubMedGoogle Scholar
  • 2 Ebbehoj J, Metz P. New operation for „krummerik” (penile curvature).  Urology. 1985;  26 76-78
    CrossrefPubMedGoogle Scholar
  • 3 Mufti G R, Aitchison M, Bramwell S P, Paterson P J, Scott R. Corporeal plication for surgical correction of Peyronie's disease.  J Urol. 1990;  144 281-283
    PubMedGoogle Scholar
  • 4 Knispel H H, Gonnermann D, Huland H. Modified surgical technique to correct congenital and acquired penile curvature.  Eur Urol. 1991;  20 107-112
    PubMedGoogle Scholar
  • 5 Klevmark B, Amdersen M, Schultz A, Talseth T. Congenital and acquired curvature of the penis treated surgically by plication of the tunica albuginea.  Br J Urol. 1994;  74 501-506
    PubMedGoogle Scholar
  • 6 Nooter R I, Bosch J LHR, Schroeder F H. Peyronie's disease and congenital penile curvature: long-term results of operative treatment with the plication procedure.  Br J Urol. 1994;  74 497-500
    PubMedGoogle Scholar
  • 7 Poulsen J, Kirkeby H J. Treatment of penile curvature: a retrospective study of 175 patients operated with plication of the tunica albuginea or with Nesbit procedure.  Br J Urol. 1995;  75 370-374
    PubMedGoogle Scholar
  • 8 Levine L A, Lenting L E. A surgical algorithm for the treatment of Peyronie's disease.  J Urol. 1997;  158 1362-1363
    PubMedGoogle Scholar
  • 9 Thioun N, Missirliu A, Zerbib M, Larrouy M, Dje K, Flam T, Debré B. Corporeal plication for surgical correction of penile curvature.  Eur Urol. 1998;  33 401-404
    CrossrefPubMedGoogle Scholar
  • 10 Brake M, Keller H, Lamadé F, Groh R, Horsch R. Operative Korrektur der Penisdeviation.  Urologe [A]. 1999;  38 264-269
    CrossrefPubMedGoogle Scholar
  • 11 Schultheiss D, Meschi M R, Hagemann J, Truss M C, Stief C G, Jonas U. Congenital and acquired penile deviation treated with the Essed Plication method.  Eur Urol. 2000;  38 167-171
    CrossrefPubMedGoogle Scholar
  • 12 Porst H. Corporoplasty in congenital and acquired penile deviations: technique and outcome in 62 patients.  Urologe [A]. 1989;  28 168-171
    PubMedGoogle Scholar
  • 13 Sassine A M, Wespes E, Schulman C C. Modified corporoplasty for penile curvature: 10 years' experience.  Urology. 1994;  44 419-421
    CrossrefPubMedGoogle Scholar
  • 14 Pryor J P, Fitzpatrick J M. A new approach to the correction of the penile deformity in Peyronie's disease.  J Urol. 1979;  122 622-623
    PubMedGoogle Scholar
  • 15 Ralph D J, Al-Akraa M, Pryor J P. The Nesbit operation for Peyronie's disease: 16-year experience.  J Urol. 1995;  154 1362-1363
    PubMedGoogle Scholar
  • 16 Rehman J, Benet A, Minsky L S, Melman A. Results of the surgical treatment for abnormal penile curvature: Peyronie's disease and congenital deviation by modified Nesbit plication (tunical shaving and plication).  J Urol. 1997;  157 1288-1291
    PubMedGoogle Scholar
  • 17 Licht M R, Lewis R W. Modified Nesbit procedure for the treatment of Peyronie's disease: a comparative outcome analysis.  J Urol. 1997;  158 460-463
    PubMedGoogle Scholar
  • 18 Daitch J A, Angermeier K W, Montague D K. Modified corporoplasty for penile curvature: long-term results and patient satisfaction.  J Urol. 1999;  162 2006-2009
    PubMedGoogle Scholar
  • 19 Belgrano E, Liguori G, Trombetta C, Siracusano S. Correction of complex penile deformities by modified Nesbit procedure asymmetric tunica albuginea excision.  Eur Urol. 2000;  38 172-176
    CrossrefPubMedGoogle Scholar
  • 20 Rigaud G, Berger R E. Corrective procedures for penile shortening due to Peyronies's disease.  J Urol. 1995;  153 368-370
    CrossrefPubMedGoogle Scholar
  • 21 El-Sakka A I, Rashwan H M, Lue T F. Venous patch graft for Peyronie's disease. Part II: Outcome analysis.  J Urol. 1998;  160 2050-2053
    PubMedGoogle Scholar
  • 22 Akkus E, Özkara J, Alici B, Demirkesen O, Hattat H. Incisional venous patch in Peyronie's disease.  Int J Impot Res. 1998;  10 A480
    PubMedGoogle Scholar
  • 23 Arena F, Peracchia G, di Stefano C, Barbieri A, Cortellini P. Peyronie's disease - incision and dorsal vein grafting combined with contralateral plication in straightening the penis.  Scand J Urol Nephrol. 1999;  33 181-185
    PubMedGoogle Scholar
  • 24 Moriel E Z, Grinwald A, Rajfer J. Vein grafting of tunical incisions combined with contralateral plication in the treatment of penile curvature.  Urology. 1994;  43 697-701
    CrossrefPubMedGoogle Scholar
  • 25 Ralph D J. What's new in Peyronie's disease.  Curr Opin Urol. 1999;  9 569-581
    CrossrefPubMedGoogle Scholar
  • 26 Kardioglu A, Tefekli A, Usta M, Demirel S, Tellaloglu S. Surgical treatment of Peyronie's disease with incision and venous patch technique.  Int J Impot Res. 1999;  11 75-78
    CrossrefPubMedGoogle Scholar
  • 27 Levine L A, Lenting E L. A surgical algorithm for the treatment of Peyronie's disease.  J Urol. 1997;  158 2149-2152
    PubMedGoogle Scholar
  • 28 Montorsi F, Salonia A, Maga T, Bua L, Guazzoni G, Barbieri L, Barbagli G, Chiesa R, Pizzini G, Rigatti P. Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease.  J Urol. 2000;  163 1704-1708
    PubMedGoogle Scholar
  • 29 Teloken C, Grazziotin T, Rhoden E, da Ros C, Fornari A, Soares F C, Souto C. Penile straightening with crural graft of the corpus cavernosum.  J Urol. 2000;  164 107-108
    PubMedGoogle Scholar
  • 30 Knoll L D. Use of small intestine submucosal graft in the surgical therapy of Peyronie's disease.  J Urol. 2000;  163 A989
    PubMedGoogle Scholar
  • 31 Devine C J, Horton C E. Surgical treatment of Peyronie's disease with a dermal graft.  J Urol. 1974;  111 44-49
    PubMedGoogle Scholar
  • 32 Pryor J P, Fitzpatrick J M. A new approach to the correction of the penile deformity in Peyronie's disease.  J Urol. 1979;  122 622-626
    PubMedGoogle Scholar
  • 33 Das S, Amar A D. Peyronie's disease: excision of the plaque and grafting with tunica vaginalis.  Urol Clinics North Amer. 1982;  9 197-201
    PubMedGoogle Scholar
  • 34 Bichler K H, Flüchter S H, Harzmann R, Erdmann W D. Experiences with the surgical management of Peyronie's disease.  Prog reprod Biol Med. 1983;  9 85-91
    PubMedGoogle Scholar
  • 35 Flüchter S H, Bichler K H, Hettich R, Harzmann R. Operative Therapie der Induratio penis plastica.  Akt Urol. 1983;  14 250-253
    PubMedGoogle Scholar
  • 36 Dalkin B L, Carter M F. Venogenic impotence following dermal graft repair for Peyronie's disease.  J Urol. 1991;  146 849-852
    PubMedGoogle Scholar
  • 37 Helal M A, Lockhart J L, Sanford E, Persky L. Tunica vaginalis flap for the management of disabling Peyronie's disease: Surgical technique, results, and complications.  Urology. 1995;  46 390-392
    CrossrefPubMedGoogle Scholar
  • 38 Gelbard M K. Relaxing incisions in the correction of penile deformity due to Peyronie's disease.  J Urol. 1995;  154 1457-1460
    PubMedGoogle Scholar
  • 39 Grein U, Schreiter F. Kavernöse Insuffizienz nach Dermalkorporoplastik.  Urologe A. 1996;  35 11-13
    PubMedGoogle Scholar
  • 40 Lahme S, Wechsel H W, Bichler K H, Schneider M. Operative Korrektur der Induratio penis plastica.  T & E Urol Nephrol. 1998;  10 147-148
    PubMedGoogle Scholar
  • 41 Savoca G, Ciampalini S, de Stefani S, Trombetta C, Belgrano E. Epidermoid cyst after dermal graft repair of Peyronie's disease.  Br J Urol. 1999;  84 1098-1099
    PubMedGoogle Scholar
  • 42 Hellstrom W JG, Reddy S. Application of pericardial graft in the surgical management of Peyronie's disease.  J Urol. 2000;  163 1445-1447
    PubMedGoogle Scholar
  • 43 Lahme S, Bichler K H. Kollagenvlies zur Defektdeckung nach Plaque-Exzision bei Patienten mit Induratio penis plastica. Akt Urol im Druck
    Google Scholar
  • 44 Fournier Jr G R, Lue T F, Tanagho E. Peyronie's plaque: surgical treatment with the carbon dioxide laser and a deep dorsal vein patch graft.  J Urol. 1993;  149 1321-1325
    PubMedGoogle Scholar
  • 45 Kim E D, Mc Vary K T. Long-term followup of the treatment of Peyronie's disease with plaque incision, carbon dioxide laser plaque ablation and placement of a deep dorsal vein patch graft.  J Urol. 1995;  153 1843-1846
    PubMedGoogle Scholar
  • 46 Branningan R E, Kim E D, Oyasu R, Mc Vary K T. Comparison of tunica albuginea substitutes for the treatment of Peyronie's disease.  J Urol. 1998;  159 1064-1068
    PubMedGoogle Scholar
  • 47 Raz S, deKernion J B, Kaufman J J. Surgical treatment of Peyronie's disease: A new approach.  J Urol. 1977;  117 598-602
    PubMedGoogle Scholar
  • 48 Carson C C, Hodge G B, Anderson E E. Penile prosthesis and Peyronie's disease.  Br J Urol. 1983;  55 417-421
    PubMedGoogle Scholar
  • 49 Eigner E B, Kabalin J N, Kessler R. Penile implants in the treatment of Peyronie's disease.  J Urol. 1991;  145 69-71
    PubMedGoogle Scholar
  • 50 Wilson S K, Delk J R. A new treatment for Peyronie's disease: modelling the penis over an inflatable penile prosthesis.  J Urol. 1994;  152 1121-1123
    PubMedGoogle Scholar
  • 51 Herschorn S, Ordorica R C. Penile prosthesis insertion with corporeal reconstruction with synthetic vascular graft material.  J Urol. 1995;  154 80-84
    PubMedGoogle Scholar
  • 52 Montague D K, Angermeier K W, Lakin M M, Ingleright B J. AMS 3-Piece inflatable penile prosthesis implantation in men with Peyronie's disease: comparison of CX and Ultrex cylinders.  J Urol. 1996;  156 1633-1635
    PubMedGoogle Scholar
  • 53 Montorsi F. AMS 700CX inflatable penile implants for Peyronie's disease: functional results, morbidity, and patient-partner satisfaction.  Int J Impot Res. 1996;  8 81-85
    PubMedGoogle Scholar
  • 54 Carson C C. Penile prosthesis implantation in the treatment of Peyronie's disease.  Int J Impot Res. 1998;  10 125-128
    CrossrefPubMedGoogle Scholar
  • 55 Wilson S K, Cleves M A, Delk J R, van Buren A R. Longterm followup of a treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis.  J Urol. 2000;  163 987A
    PubMedGoogle Scholar

Prof. Dr W L Strohmaier

Klinik für Urologie und Kinderurologie
Klinikum Coburg

Ketschendorfer Str. 33
96450 Coburg

Phone: Tel. 09561/226301

Fax: Fax 09561/226391

Email: E-mail: walter.strohmaier@klinikum-coburg.de

      >