New Developments in Surgical Treatment for Penile Size Preservation in Peyronie's Disease

Introduction: Peyronie's disease (PD) is associated with penile length loss due to atrophy that occurs as a result of fibrous inelastic scarring. Studies have shown diminished penile length and girth, as well as the inability to participate in sexual activity, can lead to decreased quality of life, emotional challenges, and sexual dissatisfaction in a large percentage of men. Aim: To provide a summary of the new developments in the surgical techniques available for the PD patient, with a focus on procedures that provide penile size restoration. Methods: A MEDLINE PubMed search was used to identify articles related to surgical treatments for PD, including plication procedures, penile prosthesis placement, and techniques for size restoration. Main Outcome Measure: Types of surgical treatments for PD and their outcomes regarding penile length and patient satisfaction. Results: The Nesbit procedure, among other plication procedures, and penile prosthesis placement with modeling or plication are likely to decrease penile length. Although plaque incision with grafting offers restoration of penile length, it carries a risk of postoperative erectile dysfunction (ED). For men with concomitant ED and severe curvature not amenable to prosthesis with modeling or plication, options include grafting, circumferential tunical incisions, subcoronal prosthesis placement, and the sliding technique with its modifications, allowing for management of both PD and ED while restoring penile length. Adjunct procedures, such as ventral phalloplasty and suspensory ligament release, have also been shown to restore length in PD patients. Novel therapies continue to evolve with the goal of preserving length while treating curvature. Conclusion: There are numerous surgical options for correcting penile curvature in PD patients, with or without concomitant ED treatment. When determining the optimal procedure, it is important to consider possible preservation of penile length and to discuss possible complications to increase patient satisfaction and improve quality of life. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.