Penile Deformity Assessment
Peyronie’s disease is associated with not only curvature but also various other deformities such as indentations, tapering, and hourglass deformity. It is important to obtain a properly performed deformity assessment in order to establish an accurate base
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Penile Deformity Assessment John P. Mulhall and Lawrence C. Jenkins
Introduction Peyronie’s disease is known to cause penile deformity after the formation of fibrotic plaques within the tunica albuginea. However, the cause of the disease is not well known, but our current understanding is that it is secondary to repetitive trauma in a man with a genetic predisposition for dysregulated wound healing in the tunica albuginea. The subsequent scar formation, known as plaques, can cause not only curvature but also various other deformities like indentation, tapering, and hourglass deformity. The curvature is most commonly dorsal but can be lateral or ventral and can also be in multiple planes (biplanar), and many patients have curvature associated with another non-curvature-type deformity. Grading the level of curvature is difficult. Penile curvature has been classified as mild (60°) according to the Kelami classification. However, this is not a universally accepted grading method. We prefer to us the following system: minimal ≤10°, mild 11–30°, moderate 31–60°, severe 61–90°, and profound >90°. We consider it important to obtain a properly performed deformity assessment in order to establish an accurate baseline prior to any intervention, whether it be medical or surgical. Furthermore, for the candidate for intralesional collagenase (Xiaflex®, Endo Pharmaceuticals; Malvern, PA), identifying the point of maximal curvature is critical to the success of this treatment.
J.P. Mulhall, MD, MSc, FECSM, FACS (*) • L.C. Jenkins, MD, MBA Department of Surgery, Section of Urology, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, Suite 402, New York, NY 10022, USA e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 J.P. Mulhall, L.C. Jenkins (eds.), Atlas of Office Based Andrology Procedures, DOI 10.1007/978-3-319-42178-0_7
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J.P. Mulhall and L.C. Jenkins
Indications Prior to intervention in men with Peyronie’s disease
Pre-procedural Considerations We encourage patients to remain off any on-demand phosphodiesterase 5 inhibitor for the 24–36 h prior to intracavernosal injection (ICI) to minimize the risk for priapism. Patients using daily tadalafil for ED or BPH/LUTS may remain on the regimen. A good goniometer and ruler are important to properly measure the deformities (Fig. 7.1). Prior to ICI, we recommend measuring the stretched flaccid length of the penis from the pubic bone to the coronal sulcus. In addition, vital signs (blood pressure and heart rate) should be checked to ensure they are within normal limits in case phenylephrine is needed at the end of the procedure to reverse the erection (see Chapter 18 on Office Management of Prolonged Erection/Priapism).
Fig. 7.1 Measuring devices
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Procedure ICI should be given and re-dosed as necessary to achieve an erection rigidity of >80 %. This is very important because the degree of curvature is directly related to rigidity. We use Trimix (papaverine 30 mg, phentolamine 10 mg
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