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abstract

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Long-term surgical, functional and patients’ reported outcomes of the turin's corporoplasty: results from a tertiary referral center experience

Marco, F1; Cirigliano, L1; Ceruti, C1; Timpano, M1; Sedigh, O1; Preto, M1; Sibona, M1; Gontero, P1; Rolle, L1

1: Urology dpt, University of Turin, Italy

Objectives: In 2005, we proposed an effective modification of Nesbit’s corporoplasty.

To report long-term surgical, functional and patients’ reported (PROs) outcomes of Turin’s corporoplasty.

Methods: From May 2005 to May 2016, 145 consecutive patients underwent Turin’s corporoplasty for a penile deformation. Clinical records were retrospectively reviewed. 87 patients, presenting full intraoperative and postoperative information were included in the present study. Etiology was congenital curvature (A) in 61 patients and Peyronie’s disease (PD) (B) in the remainders. The intraoperative complications, the hospital stay and the postoperative complications were selected as variables for the surgical outcomes. Validated questionnaires (IIEF and SEP 2,3) were administered preoperatively and 12 months after surgery. Finally, an “ad-hoc” questionnaire was submitted to assess long-term PROs.

Results: Patients’ features are summarized in table 1. The average follow-up time was 97 months. No major intraoperative complications were reported. The median hospital stay was 2 days for both group. The postoperative haematomas were graded through a haematoma scale (range 1-5) and they showed to be more frequent (p=0.003) in the group A (median score of 2, IQR 1-2) when compared to the group B (median score 1, IQR 1-2). Postoperative complications, in terms of bleeding, infection or unaesthetic scarring, resulted a rare event (13.6%) without a significant difference in-between groups. A recurrent curvature was observed in 9.9% of cases. A minor residual curvature (< 20°) was detected in 14.8% of patients. Functional outcomes are summarized in table 2. The IIEF score improved in both groups as well as the SEP 2,3. Long-term postoperative erectile dysfunction (ED) was observed in 3.2% of case in group A and in 43.5% in group B (p=0.001). Long-term PROs (table 3) demonstrated a higher incidence of dissatisfaction for penile length loss in group B compared to group A (p=0.001). Nevertheless, a sharply higher improvement of quality of both everyday life and sexual life was observed in group A compared to group B (p=0.01; p=0.004). Finally, the multivariate statistical analysis evidenced as independent risk factors for the development of postoperative ED the etiology (PD), the age (> 35) and the incidence of postoperative complications (table 4).

Conclusions: Turin’s corporoplasty represents an easy and effective approach to correct penile deformation. Despite the overall low incidence of postoperative complications, both functional and PROs tend to be sharply lower in patients with PD compared to congenital deformations.

 

Table 1.

Descriptive characteristics of the cohort of 87 patients underwent the modified Nesbit corporoplasty

 

 

Etiology

 

Variables

Total

Congenital curvature

Peyronie’s disease

p-value

Number of patients, n (%)

87

61 (70.1)

26 (29.9)

Median age (IQR), years

30 (20-54)

23 (19-31)

57 (54-65)

0.0001

Follow-up (IQR), months

97 (15-12)

92 (15-113)

102 (23.5-121-5)

0.6

Risk factor

  Smoke, n (%)

31 (34.5)

20 (34.48)

11 (47.83)

0.2

  Diabetes, n (%)

5 (6.2)

1 (1.7)

4 (17.4)

0.008

  Hypertension, n (%)

15 (18.5)

5 (8.6)

10 (43.5)

0.0001

Penile curvature

  Dorsal, n (%)

  Ventral, n (%)

  Lateral, n (%)

26 (29.8)

46 (52.9)

15 (17.2)

6 (9.8)

44 (72.1)

11 (18)

20 (76.2)

2 (7.7)

4 (15.4)

0.0001

Degree of curvature (IQR), °

60 (45-70)

60 (45-70)

45 (45-60)

0.35

Hospital stay (IQR), day

2 (1-2)

2 (1-2)

1 (1-2)

0.7

Operative time (IQR), minutes

130 (110-150)

130 (115-150)

120 (140-95)

0.1

Haematoma Scale (IQR), n

1 (1-2)

2 (1-2)

1 (1-2)

0.003

Postoperative complications, n (%)

11 (13.6)

9 (15.5)

2 (8.7)

0.4

Circumcision, n (%)

73 (90.1)

53 (91.38)

20 (86.9)

0.5

VAS Scale (IQR), n

6 (4-7)

6 (5-7)

6 (4-6)

0.1

Curvature recurrence, n (%)

8 (9.9)

3 (5.2)

5 (21.7)

0.02

Residual curvature <20, n (%)

12 (14.8)

9 (15.5)

3 (13)

0.7

Postoperative ED, n (%)

16 (19.7)

2 (3.2)

10 (43.5)

0.001

                 

Table 2.

Functional outcome assessed trough international validated questionnaires in the cohort of 87 patients underwent the modified Nesbit corporoplasty

 

 

Etiology

 

Variables

Total

Congenital curvature

Peyronie’s disease

p-value

Number of patients, n (%)

87

61 (70.1)

26 (29.9)

IIEF

   Preoperative (IQR), n

45 (17-56)

65 (61-70)

41 (19-59)

0.005

   12 months (IQR), n

65 (59-71)

68.5 (62-72)

60 (53-65)

0.005

SEP 2

   Preoperative, n (%)

45 (56.2)

34 (59.6)

11 (47.8)

0.3

   12 months, n (%)

80 (100)

57 (100)

23 (100)

1

SEP 3

   Preoperative, n (%)

17 (21.5)

11 (19.3)

6 (26.1)

0.5

   12 months, n (%)

73 (91.3)

54 (94.7)

19 (82.6)

0.08

Table 3.

Patient-reported outcomes (PRO’s) in the cohort of 87 patients underwent the modified Nesbit corporoplasty

 

 

Etiology

 

Variables

Total

Congenital curvature

Peyronie’s disease

p-value

Number of patients, n (%)

87

61 (70.1)

26 (29.9)

Bothered by penile length loss,

n (%)

23 (28.4)

12 (19)

11 (61.1)

0.001

Subjective improvement of penile axis

after surgery, n (%)

75 (92.5)

56 (96.5)

19 (82.6)

0.03

Overall improvement of sexual life

after surgery, n (%)

69 (85.2)

53 (91.4)

16 (69.6)

0.01

Overall improvement of quality

of life, n (%)

68 (83.5)

53 (91.3)

15 (65.2)

0.004

Increased frequency of sexual intercourses, n (%)

55 (67.9)

42 (72.4)

13 (56.5)

0.16

Would suggest the surgical operation

to a friend, n (%)

68 (83.9)

52 (89.6)

16 (69.6)

0.02

Modification of glans sensivity

0.5

  None, n (%)

  Hyposensivity, n (%)

  Hypersensivity, n (%)

20 (49.38)

37 (45.68)

4 (4.9)

30 (51.72)

26 (44.8)

2 (3.4)

10 (43.48)

11 (47.8)

2 (8.7)

Disclosure:

Work supported by industry: no.

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