Penile Plication for Peyronie's Disease: The Iterative 8-Dot Technique

Abstract

Introduction: Penile plication is a minimally invasive and effective technique for managing mild to severe curvature from Peyronie's disease.

Methods: Retrospective chart review of all patients undergoing penile plication for Peyronie's disease by one surgeon at one academic institution from November 2016-December 2020 was conducted. Those occurring during IPP placement were excluded. Technical aspects of surgery were detailed and intraoperative video footage was made to illustrate the technique including papaverine injection, incision and variations, tissue dissection, iterative 8-dot plication with absorbable suture, and post-operative evaluation. Primary outcomes were intra-operative and long-term success.

Results: A total of 66 patients were included. Median age was 58 years old (Range 24-73 years old). Average preoperative curvature was 45 degrees (Range 20-90 degrees). Curvature direction included 64% dorsal, 20% dorsolateral, 8% ventral, 5% ventrolateral, 3% lateral. Overall, 55% had complex deformities (biplanar curvature (38%), curvature of >60 degrees (50%), or both (11%)). Hinge effect was present in 14% of patients. Erectile dysfunction was present in 57% of patients. Ventral minimally invasive incisions were most common (64%) followed by circumcising incisions (24%), only 9% of patients had concurrent circumcision. Median number of 8-dot plication sutures used was 3 (Range 1-12). Intraoperative success, defined as completely straight was 97%. The 2 technical failures were directly related to ability to maintain intraoperative erection. Mean follow up was 4.5 months (IQR 1.1-4.2) and 91% of patients reported straight erections at follow up. No patient with hinge effect had a intraoperative failure or recurrence. There were no major complications. Rate of minor complication (superficial dehiscence, hematoma) was 6%. There were no revision plication procedures or patients who proceeded to penile implant surgery.

Conclusions: This iterative approach to penile plication with absorbable suture is an effective, minimally invasive, and reproducible technique for correcting acquired penile curvature.