Does pre-operative penile ultrasound help with surgical planning in patients with Peyronie’s Disease and erectile dysfunction?
Hawksworth, DJ1; Rajih, E1; Ali, O2; Burnett, AL1
1: JOHNS HOPKINS BRADY UROLOGICAL INSTITUTE, United States; 2: JOHNS HOPKINS MEDICAL INSTITUTIONS, RADIOLOGY DEPARTMENT, United States
Introduction and Objective: Peyronie’s disease (PD) affects an estimated 5% of men and up to 30% of them have concomitant erectile dysfunction (ED) refractory to medical therapy. Prior reports demonstrate that the majority of these men required adjunctive corrective procedures at time of inflatable penile prosthesis (IPP) implantation, with only 4% achieving spontaneous curvature resolution with IPP alone. Our objective is to correlate pre-operative penile examination and ultrasound results to intra-operative findings in order to reliably predict need for adjunctive corrective procedures at time of IPP implantation.
Method(s): Consecutive records of patients who underwent inflatable penile prosthesis (IPP) implantation at our institution between May 2007 and March 2017 were queried retrospectively. Records of patients with concomitant PD and ED diagnoses were evaluated. Patient demographics, pre-operative workup and operative data were reviewed. Based on the complexity of straightening procedures performed, patients were grouped into the following three sub-categories:
- Mild (modeling only),
- Moderate (corporoplasty +/- modeling, scar excision alone),
- Severe (corporoplasty +/- modeling + Allograft placement, corporoplasty + Nesbit, scar excision +/- corporoplasty or scar excision + Allograft).
Standard statistical calculations were utilized.
Result(s): Total of 62 out of 898 patient records were identified and reviewed. Patient’s average age was 60 years (range: 42-81yo). 54/62 (87.1%) patients reported a penile deformity at time of pre-operative consultation and 43/60 (71.7%) of them had an abnormal penile examination consistent with PD. Two patients declined physical examination. 8 (12.9%) patients with no reported pre-operative curvature and normal exam were diagnosed with penile deformities intra-operatively and necessitated further straightening maneuver(s). Pre-operative examination diagnostic of PD correlated with intra-op findings in 41/60 (68%) of all presenting patients. 39 (62.9%) patients had a pre-operative penile duplex ultrasound performed, and out of those 92.3% demonstrated a penile tissue abnormality suggestive of PD. The ultrasound findings correlated with intra-operative findings in 91.9% of the patients. Four out of the six patients in the “severe” category had tunical calcifications identified and their complex cases required 75 minutes of the additional operative time.
Conclusion(s): Sonographic confirmation of a penile tissue abnormality has the highest predictive value for need of additional straightening maneuvers at time of IPP implantation in patients with ED and PD. Tunical calcifications help predict necessity for more complex maneuvers and additional operative time required.
Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.Go Back