Levine and Lenting developed an algorithm for the surgical management of patients with Peyronie's disease who fail conservative management. The algorithm matches the surgical complexity of the procedure with the severity of the penile deformity and degree of erectile capacity. The authors are from Rush-Presbyterian-St. Luke's Medical Center in Chicago.
Erectile capacities determined:
(1) subjective: erection reported by the patient in response to a sexual stimulus
(2) objective: erected noted by health care provider following intracorporeal injection of a vasoactive agent
Subjective and/or Objective Erectile Capacity
Surgical Approach(es)
full
either (a) tunica albuginea plication or
(b) incision or partial excision with dermal grafting
suboptimal
penile prosthesis placement
Appearance
Tunica Albuginea Plication (all of the following present)
Incision or Partial Excision and Dermal Grafting (one or more of the following)
curvature
simple, < 60°
>= 60°
complex
bidimensional
hourglass deformity
absent
present
hinge effect
absent
present
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