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Five-year follow-up of Peyronie's graft surgery: outcomes and patient satisfaction.

INTRODUCTION: Graft surgery for Peyronie's disease (PD) is associated with significant long-term risks.

AIM: To evaluate the clinical and functional outcomes of graft repairs with a minimum of 5-year follow-up.

METHODS: A retrospective review of database and third party telephone survey was undertaken in all men who underwent reconstructive graft procedures for PD between May 1999 and May 2005.

MAIN OUTCOME MEASURES: Patient demographics, International Index of Erectile Function (IIEF-5) scores, and penile Doppler ultrasonography were performed preoperative. Follow-up assessments included surgical outcomes and overall patient satisfactions.

RESULTS: A total of 86 patients with an average age of 54.6 (34 to 73) years underwent Peyronie's graft repair. The average follow-up was 98 (61 to 120) months. Twenty patients received dermal graft whereas 33 patients underwent Tutoplast graft and 33 patients had Stratasis small intestinal submucosa graft. Penile curvature greater than 60 degrees was more common in the Tutoplast and Stratasis groups. Twelve patients used phosphodiesterase type 5 inhibitors or intracavenous agents preoperatively. At the time of review, only 46 (53%) patients were able to be contacted and consented for telephone interview. Although 6 months of postoperative follow-up showed excellent resolution, or significantly less, penile curvature, this figures decreased to 50% in dermal, 87% in Tutoplast, and 76% in Stratasis patients. Further penile length shortening was also reported on patient self-assessment at the recent follow-up. Worsening of IIEF-5 scores were noted with the development of erectile dysfunction was more pronounced in the diabetic cohort (P<0.01). The overall satisfaction on a 5-point scale was 2.6 with more than 65% of patients dissatisfied with the outcomes of the Peyronie's graft surgery.

CONCLUSIONS: The recurrence of penile curvature, penile length loss, and the new-onset of ED are not uncommon sequelae and are associated with a significant patient dissatisfaction rate when a 5-year follow-up is achieved.

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