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Ces Urol 2016; 20(1): 48–56
ORIGINÁLNÍ PRÁCE
reports showed relatively high rates (15–61%) of
impaired erectile function (EF) postoperatively in
the group of patients with leghtening and grafting
procedures (18, 19, 20). None of our patients took
medication for EF preoperatively, what had been
proven to be a positive prognosticator (21, 22).
With respect to our short term findings, we have
demonstrated high satisfactory rates. Even in uncir‑
cumcised men, we did not observe any bothering
complications. What supports the current view on
prepucium preservation in patients undergoing
penile degloving procedures. The mandatory is
to identify the avascular plane beween dartos and
Buck’s fascia. Generally, the overall complication
rate is less than 1%, as presented by Garaffa et al.
in the largest study (of 113 not circumcised pati‑
ents) to date. The risk of prepucial adverse events
is higher in patients with previous degloving ope‑
rations and phimosis (23).
Nevertheless, longer follow up is mandatory,
because recurrence of curvature or new onset
of ED are not uncommon sequelae within a time
frame of 5 years (24). Therefore, true rates of penile
shortening and ED after the surgery are generally
difficult to estimate. To our knowledge, there are
no studies comparing the surgical outcomes with
the controls. What makes to extrapolate the out‑
come data into the general PD patient’s population
after surgery slightly obscure. The extrapolation
of the outcome data into the general PD patients´
population is still slightly obscure. Surgery remains
the mainstay of PD treatment for complex deformi‑
ties. Until the true nature of mechanism by which
PD develops remains unclear, it will be difficult
to optimize the patient’s management and final
outcome. Understanding the mechanical aspects
of PD and the reason why, the disease tends to
progress pose the crucial factors for the future
multimodal treatment approach.
We believe that our modification can be an op‑
tional and acceptable enhancement of the current
surgical knowledge. However, one of the major
limitation is the small patient sample. That is why
we did not perform any statistical analysis and
clinicians should take our results with caution until
proven otherwise in a larger patients population
with at least moderate follow up.
CONCLUSION
We have demonstrated favorable outcomes in
a very small subset of patients with biplanar defor‑
mities in conjunction with the Peyronie’s disease.
An additional suture placement directly on the
pericard graft did not result in a higher complica‑
tion rate. According to our preliminary results we
presume, that our modification seems to be a safe
procedure. Nevertheless, it has to be further tested
on a larger patient’s scale with longer follow-up.
LITERATURE
1. Kadioglu A, Küçükdurmaz F, Sanli O.
Current status of the surgical management of Peyronie‘s disease.
Nat Rev Urol. 2011 Feb; 8(2): 95–106.
2. Kuehhas FE, Weibl P, Georgi T, Djakovic N, Herwig R.
Peyronie‘s Disease: Nonsurgical Therapy Options.
Rev Urol. 2011; 13(3): 139–146.
3. Zámečník L, Stolz J, Soukup V, Hanuš T.
Využití lokální aplikace interferonu-ala2B v léčbe induration
penis plastica. Ces Urol 2004; (1): 11–13.
4. Horák A, Krhut J, Mainer K.
Využití nízkovýkonného laseru v terapii Peyroneho choroby. Ces Urol 2001;
(3): 18–21.
5. Gelbard MK, Chagan L, Tursi JP.
Collagenase Clostridium histolyticum for the Treatment of Peyronie‘s Di‑
sease: The Development of This Novel Pharmacologic Approach. J Sex Med. 2015 Jun; 12(6): 1481–1489.
6. Lipshultz LI, Goldstein I, Seftel AD, Kaufman GJ, Smith TM, Tursi JP, Burnett AL.
Clinical efficacy of
collagenase Clostridium histolyticum in the treatment of Peyronie‘s disease by subgroup: results from two
large, double-blind, randomized, placebo-controlled, phase III studies. BJU Int. 2015 Oct; 116(4): 650–656.