Introduction: Nesbit’s-type procedures (tunical plication +/- incision) for Peyronie’s disease curvature necessarily shortens the convex side. Patient focused research has shown a common concern pre-operatively is penile length loss (PLL). The AUA Peyronie’s Disease Guideline does not comment on expected PLL. The European Association of Urology information leaflet gives a broad recommendation that Nesbit’s procedures are best suited in mild to moderate degrees of curvature and that a PLL of 10-15mm is to be expected. The British Association of Urological Surgeons information leaflet states Nesbit’s procedures result in 1cm PLL per 15° curvature correction. In our experience, this PLL seemed excessive.
The aim of this study was to determine length loss after correction and whether there were any predictive factors of PLL.
Methods: A 3-year prospective single centre cohort study was undertaken of all patients undergoing Nesbit’s-type procedures. Stretched penile length (cm) was measured pre and post-operatively. Prostaglandin induced erection was used throughout. Variables recorded included pre and post-operative curvature, pre and post-correction erect length, mode of correction and number of incisions/plications. Data was plotted with line of best fit to determine PLL per degree of curvature correction. Multivariate regression analysis was used to determine causal relationships between PLL and pre-operative factors.
Results: 100 patients underwent surgery. Mean pre-operative curvature was 46o (IQR 34o-54o, range 20o-91.6o). Mean post-operative curvature was 1.7o (0-5o). Mean PLL was 9mm (IQR 6-10mm, range 0-20mm). Mean PLL per 15o of curvature correction was 3.3mm+/-1.3mm S.D. Multivariate regression analysis revealed that none of the recorded variables (number of incisions/plications / degree of curvature/ direction of curvature) were significant factors in affecting PLL.
Conclusions: PLL during penile curvature correction is significantly less than previous literature and guidelines suggests. There is weak correlation between pre-operative degree of curvature and length loss. This may be due to variable plaque densities resulting in variable elastic remodelling during correction. Further analysis is required to ascertain a theoretical model predictor of length loss to enable counselling prior to penile curvature surgery. Source of
