Preoperative Clinical and Diagnostic Characteristics of Patients Who Require Delayed IPP after Primary Peyronies Repair

The Journal of Sexual Medicine - Tập 7 - Trang 1262-1268 - 2010
Hannah H. Alphs1, Neema Navai1, Tobias S. Köhler2, Kevin T. McVary1
1Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA;
2Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA

Tóm tắt

ABSTRACT Introduction Penile vascular abnormalities occur in a high proportion of patients with Peyronie’s disease (PD). Penile duplex ultrasonography (PDU) and dynamic infusion cavernosometry and cavernosography (DICC) are tools that can be used to help tailor individualized treatment for patients undergoing surgical intervention for their PD. However, precisely which parameters can be used to predict those patients with PD at risk for developing erectile dysfunction (ED) after intervention without inflatable penile prosthesis (IPP) has not been previously elucidated. Aim To evaluate preoperative vascular parameters that predispose PD patients for developing ED after intervention without IPP. Methods Twenty-six patients receiving surgical intervention for their PD at a single center were retrospectively identified. Of these, 11 (42.3%) opted for primary repair without placement of an IPP. Three (27.2%) of these 11 patients went on to develop ED postoperatively. Main Outcome Measures We compared various demographic, PDU, and DICC parameters between patients who did and did not fail primary repair of their PD. Results Mean age and follow-up of patients who went on to develop ED after repair of PD without IPP were not significantly different (P <0.05). Resistive index (RI) and end diastolic volume were significantly different between these two groups (P <0.05), while peak systolic volume, flow to maintain, and pressure decay were not significantly different. An RI cutoff of <0.80 was found to identify all patients who would later develop ED and fail primary repair without IPP. Conclusions Penile vascular assessment can aid in counseling patients about their risk of developing delayed ED after primary repair of PD. In our cohort of patients, PDU provided preoperative risk stratification for postoperative erectile dysfunction in men undergoing Peyronie’s repair without IPP. We propose the prospective study of an RI cutoff to identify patients at risk of failing primary PD repair without IPP.

Tài liệu tham khảo

Kadioglu, 2000, Color doppler ultrasound assessment of penile vascular system in men with Peyronie’s disease, Int J Impot Res, 12, 263, 10.1038/sj.ijir.3900569 Montorsi, 1994, Vascular abnormalities in Peyronie’s disease: The role of color Doppler sonography, J Urol, 151, 373, 10.1016/S0022-5347(17)34952-2 Lopez, 1993, Penile vascular evaluation of men with Peyronie’s disease, J Urol, 149, 53, 10.1016/S0022-5347(17)35997-9 Mulhall, 2005, A surgical algorithm for men with combined Peyronie’s disease and erectile dysfunction: Functional and satisfaction outcomes, J Sex Med, 2, 132, 10.1111/j.1743-6109.2005.20113.x Jordan, 1993, Preoperative evaluation of erectile function with dynamic infusion cavernosometry/cavernosography in patients undergoing surgery for Peyronie’s disease: Correlation with postoperative results, J Urol, 150, 1138, 10.1016/S0022-5347(17)35708-7 Aversa, 2005, Diagnosing erectile dysfunction: The penile dynamic colour duplex ultrasound revisited, Int J Androl, 28, 61, 10.1111/j.1365-2605.2005.00587.x Lue, 1985, Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis, Radiology, 155, 777, 10.1148/radiology.155.3.3890009 Kaufman, 1993, Evaluation of erectile dysfunction by dynamic infusion cavernosometry and cavernosography (DICC). Multi-institutional study, Urology, 41, 445, 10.1016/0090-4295(93)90505-5 Broderick, 1993, Duplex Doppler ultrasonography: Noninvasive assessment of penile anatomy and function, Semin Roentgenol, 28, 43, 10.1016/S0037-198X(05)80112-9 Kim, 2008, Subjective patient-reported experiences after surgery for Peyronie’s disease: Corporeal plication versus plaque incision with vein graft, Urology, 71, 698, 10.1016/j.urology.2007.11.065 Taylor, 2008, Surgical correction of Peyronie’s disease via tunica albuginea plication or partial plaque excision with pericardial graft: Long-term follow up, J Sex Med, 5, 2221, 10.1111/j.1743-6109.2008.00941.x Vardi, 2008, Cavernosometry: Is it a dinosaur?, J Sex Med, 5, 760, 10.1111/j.1743-6109.2008.00807.x Levine, 1996, Penile vascular assessment using color duplex sonography in men with Peyronie’s disease, J Urol, 155, 1270, 10.1016/S0022-5347(01)66239-6