Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases

Rohit S. Reddy, Maxim J. McKibben, Joceline S. Fuchs, Nabeel Shakir, Jeremy Scott, Allen F. Morey

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. Aim: To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. Methods: We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. Main Outcome Measure: Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. Results: Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3–84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P <.001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P <.001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P =.84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P >.1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P =.9) and post-operatively (19.4 vs 17.6, respectively, P =.15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P =.01) and pre-operative IIEF (odds ratio 1.14, P =.02). Clinical Implications: PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. Strength & Limitations: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. Conclusion: Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498–1505.

Original languageEnglish (US)
Pages (from-to)1498-1505
Number of pages8
JournalJournal of Sexual Medicine
Volume15
Issue number10
DOIs
StatePublished - Oct 1 2018

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Penile Induration
Telephone
Odds Ratio
Surveys and Questionnaires
Logistic Models
Demography
Outcome Assessment (Health Care)

Keywords

  • Patient-reported Outcomes
  • Peyronie's Disease
  • Plication

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

Cite this

Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. / Reddy, Rohit S.; McKibben, Maxim J.; Fuchs, Joceline S.; Shakir, Nabeel; Scott, Jeremy; Morey, Allen F.

In: Journal of Sexual Medicine, Vol. 15, No. 10, 01.10.2018, p. 1498-1505.

Research output: Contribution to journalArticle

Reddy, Rohit S. ; McKibben, Maxim J. ; Fuchs, Joceline S. ; Shakir, Nabeel ; Scott, Jeremy ; Morey, Allen F. / Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. In: Journal of Sexual Medicine. 2018 ; Vol. 15, No. 10. pp. 1498-1505.
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title = "Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases",
abstract = "Introduction: Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. Aim: To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. Methods: We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. Main Outcome Measure: Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. Results: Of 327 PP patients, 102 (31{\%}) responded to the telephone survey at a median 59.5 months (interquartile range 28.3–84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P <.001), correction of penile curvature was achieved in 91{\%} of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P <.001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5{\%} vs 74.5{\%}, P = 1.0) and sexual function (51.0{\%} vs 49.0{\%}, P =.84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P >.1), as were rates of subjective penile shortening (62.7{\%} vs 62.7{\%}, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P =.9) and post-operatively (19.4 vs 17.6, respectively, P =.15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P =.01) and pre-operative IIEF (odds ratio 1.14, P =.02). Clinical Implications: PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. Strength & Limitations: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31{\%}), and lack of validated post-operative PD questionnaire. Conclusion: Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498–1505.",
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T1 - Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases

AU - Reddy, Rohit S.

AU - McKibben, Maxim J.

AU - Fuchs, Joceline S.

AU - Shakir, Nabeel

AU - Scott, Jeremy

AU - Morey, Allen F.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Introduction: Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. Aim: To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. Methods: We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. Main Outcome Measure: Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. Results: Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3–84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P <.001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P <.001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P =.84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P >.1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P =.9) and post-operatively (19.4 vs 17.6, respectively, P =.15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P =.01) and pre-operative IIEF (odds ratio 1.14, P =.02). Clinical Implications: PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. Strength & Limitations: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. Conclusion: Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498–1505.

AB - Introduction: Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. Aim: To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. Methods: We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. Main Outcome Measure: Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. Results: Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3–84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P <.001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P <.001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P =.84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P >.1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P =.9) and post-operatively (19.4 vs 17.6, respectively, P =.15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P =.01) and pre-operative IIEF (odds ratio 1.14, P =.02). Clinical Implications: PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. Strength & Limitations: This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. Conclusion: Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498–1505.

KW - Patient-reported Outcomes

KW - Peyronie's Disease

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