AB025. Surgical treatment for Peyronie’s disease in Japan

OBJECTIVE: The prevalence of Peyronie’s Disease is 2 to 8.9% average 5%. Thus, PD is not rare disease. We will show the 17 years’ experience in Toho University. METHODS: We had 344 cases for 17 years. The average age was 51.4 years. Chief complains were curvature, palpable fibrosis, pain, ED etc. The angle of curvature was 0 to 90 degrees. About direction of curvature, 34% was upper direction, 17% were left direction and lower direction, 11% was right direction. One hundred and twenty cases (35%) were improved by medication. We usually use Tranilast as medication. Tranilast is used for Keloid and hypertrophic scar in Japan. The mechanism is suppression of TGF-β. Operations were performed after conservative treatment for 1 year. We had two operation methods, plication and grafting. After shaving tunica, we make inverted plication suture using nonabsorble 2-0 Tycron. We have two methods of saphenous vein graft. If plaque is small, we performed vein graft after plaque excision. If plaque is large, we performed rectangle type vein graft after Hourglass-shaped incision. We performed dermal graft for large defect and lateral defect. RESULTS: Ninety-three cases (27%) were performed saphenous vein graft. Seven cases (2%) were performed dermal graft. Fifty-two cases (15%) were performed plication. Satisfaction rate was 91.8%. Slight curvature remain was 6.1%. Complain short penis was 2.1%. Complication rate with ED was 0%. CONCLUSIONS: (I) Vein graft is better than plication method for Peyronie’s disease with penis shortening; (II) vein is the best as material for grafting, because the grafted vein is thin and soft; (III) the hourglass-shaped incision method is most suitable for cases of a wide plaque; (IV) we need dermal graft for large defect due to calcification of tunica and lateral defect; (V) plication method for PD with mild or moderate ED is safety, because cavernous artery from dorsal artery is cut at dorsal grafting.