Modified nesbit procedure for the treatment of Peyronie's disease: A comparative outcome analysis

Purpose: We describe a surgical modification of the Nesbit procedure to correct Peyronie's disease, and compare the results of this procedure with those of 2 other surgical techniques. Materials and Methods: In 30 patients a vertical incision in the tunica albuginea was closed in a horizontal fashion with permanent suture knots buried beneath the tunica in a running looped fashion, resulting in watertight closure with no exposed suture material. A standard Nesbit procedure and plaque excision with a polyethylene terephthalate mesh reinforced silicone sheet patch graft were done in 28 cases each. Results: Elimination of penile curvature, patient satisfaction and postoperative impotence rates were not statistically different for standard and modified Nesbit procedures. However, plaque excision and synthetic patch grafting resulted in less elimination of curvature (61%, p = 0.004), a lower rate of satisfaction (30%, p = 0.00002) and a higher incidence of impotence after surgery (18%, p = 0.04). The modified Nesbit procedure achieved an overall higher rate of correction of curvature than the standard approach (93 versus 79%). Conclusions: A modified Nesbit procedure achieves the greatest functional success for Peyronie's disease with an acceptably low complication rate.