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    The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study
    (Elsevier Sci Ltd, 2019) Ozmez, Abdulkadir; Ortac, Mazhar; Cevik, Gokhan; Akdere, Hakan; Bakir, Baris; Kadioglu, Ates
    Background: Anatomic and functional evaluation of the penis before treatment is very important in the choice of treatment in patients with Peyronie's disease (PD). Aim: To compare 3 different methods for the evaluation of the penile deformity, including auto-photography, combined intracavernous injection stimulation test (CIS), and 3-dimensional computed tomography (3D CT) during artificial penile erection in patients with PD. Methods: Pretreatment penile deformities of patients with PD were compared with those detected with autophotography, using goniometer after intracavernosal vasoactive agent, and 3D CT correlations among these 3 methods were investigated. Main Outcome Measures: Assessments of penile curvature with auto-photography, CIS, and 3D CT. Results: The mean age of 36 patients who were included in the study was 58 +/- 8.25 (36-72) years, and the mean time since the onset of the disease was 25 +/- 24 months (2-144). Degrees of penile curvatures measured using auto-photography, CIS, and CT were determined as 24 degrees (0 degrees-80 degrees), 40 degrees (0 degrees-90 degrees), and 34 degrees (0 degrees-80 degrees), respectively. When general correlation analysis was performed to evaluate the penile curvatures of all patients using 3 methods, a moderate correlation between auto-photography and both CIS (r = 0.72, P < .001) and 3D CT (r = 0.56, P < .001) was detected, whereas a strong correlation was noticed between CIS and 3D CT (r = 0.78, P < .001). When the correlation analysis between patients with and without ED was examined, a statistically significant decrease in the strength of correlation between CIS and auto-photography in patients with ED (0.629 vs 0.925, P < .05), however, was detected without any statistically significant difference in patients without ED (0.694 vs 0.813, P > .05). Conclusion: The superiority of 3D CT over auto-photography and its strong correlation with CIS in most parameters have been demonstrated. However, it was found that CT did not give more information than the evaluation with CIS. Current limitations and cost increases limit the use of 3D CT in the assessment of PD. Copyright (C) 2019, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.
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    Penile curvature after Peyronie's disease surgery: What are the risk factors?
    (Wiley, 2020) Salabas, Emre; Ozmez, Abdulkadir; Ermec, Bahadir; Cevik, Gokhan; Akdere, Hakan; Kadioglu, Ates
    Surgery is the golden standard for the treatment of patients with Peyronie's disease in chronic phase (12-18 months). Learning risk factors for post-surgical curvature (>20 degrees) would aid both surgeon and patient in their decision-making process. The aim of this study was to investigate the risk factors for residual/recurrent curvatures. The clinical data of the patients, who underwent reconstructive surgery for PD between 1997 and 2016, were retrospectively reviewed. Follow-ups were performed via physical examination, surveys and phone calls. For shortening surgery (Nesbit/plication), initial bi-planar curvature was proved to be a predictor of post-operative curvature (p = .05). Lateral and ventral curvatures were associated with higher recurrence rates in patients who underwent grafting surgery (p = .01). In terms of baseline comorbidities, only diabetes mellitus had an association with curvature nonrecurrence for both shortening and lengthening surgeries (p < .05). Grafting surgery may be suggested to patients who had bi-planar curvatures instead of Nesbit surgery. Nesbit plication surgery may be preferred for patients with lateral and ventral curvatures instead of grafting surgery. Higher cavernosal blood pressures and more nocturnal erections of nondiabetic young patients might impede plication sutures and grafts and therefore increase penile curvature recurrence.