Minimally invasive intracorporeal incision of Peyronie's plaque: initial experiences with a new technique.

摘要

OBJECTIVES: Minimally invasive repairs represent an attractive treatment approach for the surgical correction of Peyronie's disease. We describe a novel intracorporeal incision technique and the results of our ongoing experience. METHODS: In selected patients who had consented to surgical treatment of a localized Peyronie's scar, saline erection confirmed the degree and location of penile deformity. The skin was mobilized using a subcoronal, circumferential incision. After limited mobilization of the neurovascular bundle, a 1-cm incision lateral to the plaque allowed for the introduction of a triangle-shaped scalpel designed for endoscopic carpal tunnel release into the corpora. Multiple intracorporeal incisions were made, preserving the outer layer of the tunica. Saline erection confirmed curvature correction. A single pair of ventral plication sutures was required in select cases. The small corporotomy, Buck's fascia, and skin were then reapproximated. Patients were discharged home within 24 hours. RESULTS: In 23 patients, the degree of curvature ranged from 30 degrees to 90 degrees (median 60 degrees). All patients had stable curvature and difficulty with intromission. The mean follow-up was 25 months. Correction of the deformity was successful in all but 2 patients (less than 10 degrees residual curvature), with 80% of patients reporting erections sufficient for intercourse and treatment satisfaction of 85%. CONCLUSIONS: These results indicate good correction of curvature, minimal difficulties with erectile function, and high patient-reported satisfaction using our technique at a follow-up of 25 months. We continue to offer intracorporeal incision as a primary treatment option for discrete plaques less than 2 cm, using grafting techniques for larger and complex lesions.