Surgical Treatment of Peyronie’s Disease in the Older Man: Characteristics and Outcomes
As the general population ages, so does the typical male patient in a urologic practice. Moreover, the prevalence of Peyronie&[prime]s Disease (PD) increases with age. Considering surgery remains the gold standard for definitive treatment of PD, there is a paucity of data on surgical treatment in older men. We describe our experience with the surgical treatment of PD in men older than 65 years.
We performed a retrospective review of all patients 65 years or older with PD who underwent surgical treatment at our tertiary care institution from January 2010 to September 2017. Baseline characteristics were obtained by history and physical examination as well as penile duplex ultrasound with vasoactive injection. We compared pre- and post-operative characteristics of patients who underwent penile implantation with straightening maneuvers (PP+SM), tunica albuginea plication (TAP) and plaque excision with grafting (PEG).
A total of 86 men had surgery for PD with a mean age of 68 years (range: 65-79 years). Of our population, 20% had Diabetes Mellitus, 52% had hypertension, and 48% had a smoking history. Surgical management included either PP+SM (n=39, 45%), TAP (n=25, 29%) or PEG (n=22, 26%). The mean curvature for all men was 60° (range: 0-100°). Men who underwent a PEG had a mean curvature of 79°, significantly higher than men who underwent PP+SM (49°, p<0.01) or TAP (61°, p<0.01). Men who underwent PEG were also significantly more likely to have penile narrowing/indentation and/or hinge compared to men who underwent TAP (96% vs 64%, 72% vs 8% respectively, p<0.01). Patient reported baseline erectile function (1-10/10) was significantly lower in men who underwent PP+SM compared to TAP or PEG (5/10 vs 8/10 vs 9/10 respectively; p<0.01). Overall, 97% of all men reported to be straight following surgery (95% in PP+SM, 96% in TAP, 96% PEG; p>0.05) with 93% of men engaging in penetrative intercourse (95% in PP+SM, 92% in TAP, 95% in PEG; p>0.05). Post-operative sensory changes were reported in 23% of all men (23% in PP+SM, 24% in TAP, 18% in PEG; p>0.05) with no incidence of cold glans. Overall patient reported post-operative satisfaction was 85% (85% in PP+SM, 88% in TAP, 82% in PEG; p>0.05). There were 3 reported complications (1 infection, 1 seroma and 1 urinary retention). Mean follow up was 44 months (range: 1-91 months).
With the increasing adoption of non-surgical treatment modalities in PD, surgical correction in older men is safe, effective and associated with high patient satisfaction. Our outcomes suggest that surgery is a viable option for the properly selected older man with PD.