Peter Tsambarlis

Peyronie’s graft surgery—tips and tricks from the masters in andrologic surgery

Background Grafting techniques in the surgical management of Peyronie’s disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD. Methods This report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed. Results Adequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy. Conclusions The present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.

Limited success with clostridium collagenase histolyticum following FDA approval for the treatment of Peyronie’s disease

Collagenase clostridium histolyticum (CCH) was approved for the treatment of Peyronie’s disease (PD) in December of 2013. Recently, further research has supported its use. The aim of this study was to objectively evaluate the effects of CCH on penile curvature associated with Peyronie’s disease at our high volume institution. Since the approval of CCH for PD, 45 men have undergone between 1 and 4 treatment cycles (mean 3.13, standard deviation (SD) = 0.87) at our institution. Primary as well as secondary curvature, if any, was measured before beginning therapy and after each cycle of therapy. The degree of curvature was compared. We also questioned these men about their subjective experience with CCH. The mean age of this cohort was 55.7 years (range 35–70). The mean primary curvature was 53.6° (SD = 16.5). Post-treatment mean primary curvature was 48.2° (SD = 19.5), p = 0.10. Secondary curvature was reduced from 24.1° (SD = 11.3) to 20.4° (SD = 11.5) before and after treatment with CCH, respectively, p = 0.27. There were two tunical ruptures in this series after which both ceased therapy with CCH. Additionally, 37/45 patients in this series expressed some degree of dissatisfaction in their post-therapy visits with most of these men stating that they did not notice a change in their curvature. CCH remains an option for the treatment of PD. Predictors of success, however, are lacking. Our experience showed a less-robust response to CCH than previous studies and underscores the need for effective and clear patient counseling prior to the initiation of therapy with CCH for PD in the post-FDA-approval setting.

A treatment algorithm for healthy young men with erectile dysfunction

To assess baseline characteristics of a cohort of young men with erectile dysfunction (ED) but no identifiable organic cause and to evaluate the efficacy of our treatment algorithm.

Microdenervation of the spermatic cord for post-vasectomy pain syndrome

To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post‐vasectomy pain syndrome (PVPS) at our institution.

MP84-16 BASELINE CHARACTERISTICS OF YOUNG MEN WITH ERECTILE DYSFUNCTION: A SINGLE CENTER EXPERIENCE

RESULTS: More than one time waking up during night, the habit drinking every day, having smoking history were related to lower testosterone level. About the length of time using internet and playing game, there was the relationship that lower testosterone was related to low probability of using internet more than thirty minutes (Figure). There was no relationship between testosterone level and the times of night shift per month and the number of taking breakfast per week. CONCLUSIONS: Lifestyles such as internet use, night waking, drinking habit and smoking in healthy young and elderly adults are associated with testosterone levels.

Surgical Correction for Peyronie's Disease and Anatomic Abnormalities of the Penis

Peyronies disease (PD) is an acquired healing disorder of the tunica albuginea of the corpora cavernosa that results in the development of an inelastic scar and ultimately penile curvature. This is distinct from chordee, which is a congenital disorder leading to penile curvature due to asymmetric inelasticity of the tunic albuginea. We discuss the epidemiology, pathophysiology, and preoperative evaluation for patients with PD in particular. The selection of operative modality for the management of PD is dependent on several factors including quality of erections, degree of curvature, and presence of calcification or hinge effect deformity. Surgical management can be divided into shortening procedures including tunica albuginea plication (TAP) and lengthening procedures including partial plaque excision and grafting (PEG). For patients with concurrent erectile dysfunction, surgical management can include placement of inflatable penile prosthesis in combination with straightening maneuvers including manual modeling, tunical incision, and grafting.