Objectives: Etiological and pathogenic mechanisms of Peyronie's disease (PPI) are today better known than in the past, but till now therapeutic options are not completely satisfactory. In fact several therapeutic alternatives were suggested, but none demonstrated its superiority. Surgery is the preferred option in chronic stable disease with the following goals: penile straightening, penile lengthening and recovery of penetrative coital activity. Aim of this paper was to present a personal experience with modifications of the original surgical technique.
Materials and methods: From September 2005 to December 2008, a total of 58 patients (mean age 44.7 years) underwent corrective penile surgery for PPI. All patients had a single plaque with dimensions ranging 1.2-2.6 cm in length. Simple dorsal recurvatum >50 degrees was observed in 38 patients, dorsolateral left recurvatum >45 degrees in 8, ventral recurvatum >40 degrees in 6, lateral left recurvatum >45 degrees in 4, dorsolateral right recurvatum >45 degrees in 2. Forty patients were implanted with a 7 F Virilis II prosthesis, 7 with a 7 F Virilis I, 8 with 10 F Virilis I and 3 with 9.5 F SSDA prosthesis. Implanted tutor length ranged between 16.6 and 20 cm, measuring from crura to corpora apex. In 46 patients we implanted a safena graft and in 12 with recurvatum >60 degrees we used bovine pericardial collagen patch (Veritas-Hydrix).
Results: At long term follow up (1-3 years) we observed a penile elongation from 1.2 to 2.3 cm with complete correction of penile recurvatum in all the patients. After 12-36 months excellent penetrative sexual activity was referred by 75% of the patients, satisfactory in 20% and disappointing in 5%. Major complaints were "cool glans" feeling, delayed ejaculation, unnatural penis appearance due to permanent hyperextension. None developed lower urinary tract symptoms.
Conclusion: According to such results, the described technique should be considered as a gold standard for all cases of PPI associated to recurvatum > 35-40 degrees (lateral, ventral and dorsal) associated to a plaque with mild-moderate erectile dysfunction.