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October 04, 2010, 07:57:45 AM
AU Alphs HH. Navai N. Kohler TS. McVary KT.
FA Alphs, Hannah H. Navai, Neema. Kohler, Tobias S. McVary, Kevin
IN Department of Urology, Northwestern University Feinberg School of
Medicine, Chicago, IL60611-3008, USA.
TI Preoperative clinical and diagnostic characteristics of patients
who require delayed IPP after primary Peyronies repair.
SO Journal of Sexual Medicine. 7(3):1262-8, 2010 Mar.
AB INTRODUCTION: Penile vascular abnormalities occur in a high
proportion of patients with Peyronie's disease (Peyronies Disease). Penile duplex
ultrasonography (PDU) and dynamic infusion cavernosometry and
cavernosography (DICC) are tools that can be used to help tailor
individualized treatment for patients undergoing surgical
intervention for their Peyronies Disease. However, precisely which parameters can
be used to predict those patients with Peyronies Disease at risk for developing
erectile dysfunction (Erectile Dysfunction) after intervention without inflatable
penile prosthesis (IPP) has not been previously elucidated. AIM: To
evaluate preoperative vascular parameters that predispose Peyronies Disease
patients for developing Erectile Dysfunction after intervention without IPP. METHODS:
Twenty-six patients receiving surgical intervention for their Peyronies Disease at
a single center were retrospectively identified. Of these, 11
(42.3%) opted for primary repair without placement of an IPP. Three
(27.2%) of these 11 patients went on to develop Erectile Dysfunction postoperatively.
MAIN OUTCOME MEASURES: We compared various demographic, PDU, and
DICC parameters between patients who did and did not fail primary
repair of their Peyronies Disease. RESULTS: Mean age and follow-up of patients who
went on to develop Erectile Dysfunction after repair of Peyronies Disease without IPP were not
significantly different (P < 0.05). Resistive index (RI) and end
diastolic volume were significantly different between these two
groups (P < 0.05), while peak systolic volume, flow to maintain, and
pressure decay were not significantly different. An RI cutoff of
<0.80 was found to identify all patients who would later develop Erectile Dysfunction
and fail primary repair without IPP. CONCLUSIONS: Penile vascular
assessment can aid in counseling patients about their risk of
developing delayed Erectile Dysfunction after primary repair of Peyronies Disease. In our cohort of
patients, PDU provided preoperative risk stratification for
postoperative erectile dysfunction in men undergoing Peyronie's
repair without IPP. We propose the prospective study of an RI cutoff
to identify patients at risk of failing primary Peyronies Disease repair without
PT Journal Article.
AU Tal R. Heck M. Teloken P. Siegrist T. Nelson CJ. Mulhall JP.
FA Tal, Raanan. Heck, Matthias. Teloken, Patrick. Siegrist,
Timothy. Nelson, Christian J. Mulhall, John P.
IN Urology Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, NY, USA.
TI Peyronie's disease following radical prostatectomy: incidence and
SO Journal of Sexual Medicine. 7(3):1254-61, 2010 Mar.
AB INTRODUCTION: Both prostate cancer and Peyronie's disease (Peyronies Disease)
are prevalent in men after their fifth decade of life. The evidence
to support or refute a link between radical prostatectomy (RP) and
Peyronies Disease is limited. AIMS: To define the incidence of Peyronies Disease in men who had RP
and determine possible predictors of Peyronies Disease development after RP.
METHODS: A review of a prospectively built sexual medicine database,
years 2002-2008, looking at subjects who had RP as a monotherapy for
localized prostate cancer. We identified and characterized subjects
who developed Peyronies Disease within 3 years after RP and compared them with
subjects who did not. MAIN OUTCOME MEASURES: The incidence of Peyronies Disease
among men who attended a sexual medicine clinic after they had RP,
predictors of Peyronies Disease development after RP. RESULTS: The study population
included 1,011 subjects, and Peyronies Disease incidence in this population was
15.9%. Mean time to develop Peyronies Disease after RP was 13.9 +/- 0.7 months.
Mean curvature magnitude was 31 + 17 degrees. On univariate
analysis, younger age (mean age of 59 + 7 in men with Peyronies Disease vs. 60 + 7
years in men without Peyronies Disease, P = 0.006) and white race (vs non-white,
18% vs. 7%, P < 0.001) were predictive of Peyronies Disease development after RP,
but post-op erectile function was not a predictor of Peyronies Disease development.
On multivariate analysis, younger age (odds ratio (OR) = 1.3, for
5-year decrease in age) and white race (OR = 4.1, vs. non-white)
remained independent significant predictors. CONCLUSIONS: Men
presenting with sexual dysfunction after RP have higher Peyronies Disease incidence
then the general population. Therefore, they should be routinely
evaluated for Peyronies Disease. Younger men and men of white race are at increased
risk for Peyronies Disease. Prospective controlled studies are needed to elucidate
the incidence of Peyronies Disease following RP and to conclude if RP has a
causative role in the pathogenesis of Peyronies Disease.
PT Journal Article. Research Support, Non-U.S. Gov't.
52, Peyronies Disease for 30 years, upward curve and some new lesions.
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