Operative Therapie der Induratio penis plastica

Zusammenfassung

Die operative Therapie der Induratio penis plastica ist keine kausale Therapie. Sie ist nur indiziert, wenn die Deviation die Kohabitation behindert, wenn erhebliche Schmerzen dabei bestehen oder eine anderweitig behandelbare erektile Dysfunktion vorliegt. Der Aufklärung des Patienten über das zu erwartende Ergebnis und mögliche Komplikationen ist außerordentlich wichtig. Wir können zwischen Plikatur- und in-/exzidierenden Verfahren mit plastischer Deckung und Methoden mit Penisprothesenimplantation unterscheiden. Bei den Plikaturverfahren sind Methoden mit Exzision eines Ellipsoids (z. B. Nesbit-OP) den Techniken ohne Ausschneidung (z. B. Essed-Schroeder) überlegen. Nachteil der Plikaturverfahren ist die Verkürzung des Penis. Bei den in-/exzidierenden Verfahren erfolgt die Defektdeckung entweder mit körpereigenen (z. B. Vene) oder Fremdmaterialien (z. B. TachoComb®). Eine eindeutige Überlegenheit eines bestimmten Verfahrens besteht dabei nicht. Folgende Resultate werden beschrieben: persistierende/rezidivierende Deviation 17 - 29 %, postoperative erektile Dysfunktion 0 - 33 %, Penisverkürzung 0 - 100 %, Zufriedenheit 50 - 85 %, Komplikationen 0 - 50 %. Die Indikation zur Penisprothesenimplantation besteht bei gleichzeitiger erektiler Dysfunktion (in der Regel veno-okklusiv). Welches Verfahren angewandt wird, sollte individuell von der jeweiligen Befundkonstellation und den Wünschen des Patienten abhängig gemacht werden.

Abstract

Surgery for Peyronie's disease is not a causal therapy. It is indicated in men with penile deviation impeding sexual intercourse, considerable pain during erection and concomitant erectile dysfunction. An adequate information and counseling of the patient on the nature of the disease, surgical results and possible complication is important. Plication procedures, incising/excising methods with grafting and methods with prosthesis implantation can be distinguished. Among plication procedures, those with corporoplasty (e. g. Nesbit operation) are superior to techniques without corporoplasty (e. g. Essed-Schroeder). In excising/incising procedures, autologous (e. g. vein patches, tunica vaginalis, dermal grafts) or synthetic materials (e. g. TachoComb®) are used for grafting. So far, there is no evidence that one of the materials is definitively superior. The following results were reported: persistent/recurrent deviation 17 - 29 %, postoperative erectile dysfunction 0 - 33 %, shortening of the penis 0 - 100 %, patient satisfaction 50 - 85 %, complications 0 - 50 %. The indication for implantation of a penile prosthesis is concomitant erectile dysfunction (i. e. veno-occlusive type). The proper selection of the adequate procedure is dependant on the individual findings and the patient's preference.

Schlüsselwörter:

Induratio penis plastica - Morbus Peyronie - Operative Technik - erektile Dysfunktion

Key words:

Induratio penis plastica - Peyronie's disease - Surgery - Surgical treatment

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