Peyronie's disease

Question 1

incidence general
in diabetics
after RARP

Answer 1

6%
20%
15%

Question 2

8 key history questions

Answer 2

Any pain and are the changes stable?
How bad is curvature?
Any change in erectile function? Is rigidity decreased?
Any hourglass or destabilising deformity?
Is penetration possible?
How much residual length?
CV factors comorbidities
Impact on life and relationships

Question 3

prom questionnaire

Answer 3

PDQ questionnaire

only for those who have had vaginal intercourse last 3 months

Question 4

dose caverjet for diagnosis

Answer 4

10–20 micrograms for 1 dose

Question 5

doppler peak velocity
RI
risk of operation

Answer 5

PSV <35cm/s
resistive index <0.75
indicates worse outcome with treatment

Question 6

natural history of PD

paper

Answer 6

Bekos Eur Urol 2008

65% stable
30% may reactivate and progress
5% may spontaenously get better - mean gets another plaque that evens it out, doesn’t disappear, may improve in shape

Question 7

CCH degree of improvement in trial

Answer 7

33% improvement

14 degrees

Question 8

vacuum device in PD
protocol
% improvement

Answer 8

use 10 mins bd for 3 months, full erection 3 mins

50% improvement

Question 9

pre op counselling PD

Answer 9

Functionally straight <20 degrees
Recurrent  curvature
May need circumcision
Change in penile erect length
Decreased rigidity
Altered sensation
Palpable sutures, site of repair
Need to manage patient expectations

Question 10

ED with Plication vs graft

risk altered sensation with plication

Answer 10

10% vs 20-30%

<10%

Question 11

procedure nesbits

Answer 11

Circumferential degloving incision
Get below dartos
Get down to bucks fascia and expose
Lift off bucks to get down to TA
Find point of maximal curvature with allis clamps with penis erect
Mark tunica
Take out discs
Sew up buried sutures interrupted 0 or 2/0 PDS

Ventral curve same operation, take out sup dorsal vein, separate NV bundle in midline, then windows in ventral aspect