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Peyronie's disease (PD) is caused by progressive fibrotic scarring of the tunica albuginea resulting in curvature or other deformities of the erect penis. The severity of penile curvature or other deformity may contribute to a man's inability to have intercourse (sexual disability), due to difficulty with penetration, partner pain or emotional stress. To determine whether the degree of curvature or type of penile deformity predicts sexual disability among men with PD. This cross-sectional analysis of consecutive men evaluated for PD at a single tertiary referral center used a PD-specific questionnaire to evaluate risk factors for sexual disability in men with PD, who did not have erectile dysfunction (ED). Multivariate logistic regression was used to determine the clinical predictors of sexual disability. Sexual disability as defined by the inability to have penetrative intercourse. A total of 202 men were evaluated and 88 men with ED were excluded. Sexual disability was associated with relationship problems, penile curvature and penile length loss in bivariate, but not multivariate analysis. We found that although many of the demographic, medical and sexual function domains were significant predictors of inability to have sex, the only significant predictor of sexual disability in multivariate analysis was curvature>60° (odds ratio 3.23 95%CI 1.08-9.67). PD can be sexually disabling in many men without ED. Severe penile curvature is a robust independent predictor of the ability to have intercourse. Other penile deformities fail to predict sexual disability. This is important for counseling patients with newly diagnosed PD and those who are considering medical or surgical intervention.

Peyronie's disease is a fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile curvature and sexual dysfunction. Diagnosis of the disorder is made by detailed sexual history and focused physical examination. A wide range of medical treatments has been employed to treat the disorder. Verapamil treatment administered by intraplaque injection is supported by generally consistent randomized controlled trials (RCT). Some RCT evidence exists to support the use of colchicine, potaba, L-carnitine and liposomal superoxide dismutase. Future studies of medical efficacy should focus on improving RCT design, implementation and results reporting to improve the quality of evidence generated by each study. The surgical treatment of Peyronie's disease is a viable and recommended alternative for men with compromised sexual function due to severe curvature or lesions causing penile instability. The choice of corrective procedure should be tailored to each patient after a detailed evaluation of disease severity and sexual function.

Introduction: Peyronie's disease (PD) occurs in 3-9% of all men. Little is known regarding the specific psychological or emotional disruptions to sexuality associated with PD., Aim: Our primary aim was to identify risk factors associated with psychosocial difficulties in men with PD., Methods: This cross-sectional study enrolled patients from a single clinical practice. Detailed medical histories, physical examinations, and a PD-specific questionnaire were used to define clinical characteristics. Odds ratios (ORs) were used as a measure of association., Main Outcome Measures: Emotional and relationship problems were determined by "yes" or "no" answers to two specific questions., Results: The mean age of all PD patients (N = 245) was 54.4 years (range 19.4-75.6); 62% were married, and 59% presented within 2 years of disease onset. The overall prevalence of emotional and relationship problems attributable to PD was 81% and 54%, respectively. Among men who had relationship problems, the prevalence of emotional problems was 93%. In men with emotional problems due to PD, relationship issues were observed in 62%. Multivariable analysis revealed that emotional difficulties (OR 6.9, P < 0.001) and ability to have intercourse (OR 0.4, P = 0.004) were independently associated with relationship problems. Relationship problems (OR 8.0, P < 0.001) and loss of penile length (OR 2.7, P = 0.02) were significant independent predictors of emotional problems after adjustment for the ability to maintain erections, low libido, and penile pain., Conclusions: Among men with PD, there is a very high prevalence of emotional and relationship problems. Loss of penile length and inability to have intercourse are strong predictors of these problems and as such make ideal targets for intervention. Medical and surgical therapies may enhance quality of life through their ability to improve sexual function. Further research will characterize the ways in which individual symptoms affect emotional and psychological well-being.

Introduction: There are no validated scales for assessing the psychosocial impact of Peyronie's disease (PD), which affects approximately 5-10% of men over age 50., Aim: To develop a psychometrically valid outcome measure for assessing psychosocial and sexual consequences of PD. To conduct a qualitative study of men with PD and age-matched controls, and design a new patient-reported outcome measure of PD., Methods: An expert advisory panel identified relevant topics and conceptual areas to be addressed based on clinical experience and literature reviews. A conceptual model was developed to serve as a discussion guide for qualitative interviews with geographically and ethnically diverse PD subjects and controls. Interviews were conducted in a focus-group format by a trained interviewer and were recorded and transcribed for qualitative analysis according to grounded theory concepts., Main Outcome Measure: Focus-group interviews., Results: Focus-group interviews were conducted with 64 men (28 PD patients, 36 controls) in 13 separate focus groups over a 3-month period. Blinded analysis of the interview transcripts identified four core domains: (i) physical appearance and self-image; (ii) sexual function and performance; (iii) PD-related pain and discomfort; and (iv) social stigmatization and isolation. Based on feedback from participants and experts, a new outcome questionnaire was developed to assess core domain responses in a structured, self-report format., Conclusions: This qualitative study helped to refine and broaden the focus of the conceptual model for further assessment. It also confirmed that PD has a major impact on sexual and psychological function in these patients.

Transforming growth factor beta (TGF-beta) has been implicated in many chronic fibrotic conditions such as pulmonary and hepatic fibrosis. Inhibition of TGF-beta activity can prevent the development of chronic hepatitis and mesangial proliferative glomerulonephritis. We postulated that TGF-beta might play a role in the pathogenesis of Peyronie's disease (a localized connective tissue disorder that primarily affects the tunica albuginea and adjacent erectile tissue of the penis). Tissue from the tunica albuginea of thirty-five Peyronie's patients (study group) and from eight patients without Peyronie's disease who had undergone penile prosthesis surgery for organic impotence (control group) were subjected to histological study using Hart and Trichrome stains and Western blotting for the detection of TGF-beta protein expression. TGF-beta1 protein expression was detected in 30 patients (85.7%), while only 8 (22.8%) and 6 (17.1%) patients showed TGF-beta2 and TGF-beta3 protein expression, respectively. All tissue from Peyronie's patients showed a variety of histological changes of the tunica, ranging from chronic inflammatory cellular infiltration to complete calcification and ossification of the tissues. The most prominent changes observed were focal or diffused ellastosis, fenestration, and disorganization of the collagen bundles. One patient in the control group showed fibrosis of the tunica albuginea and protein expression of TGF-beta1 and TGF-beta2. This patient had undergone surgery for the revision of his prosthesis twice. However, the other seven patients showed normal histologic patterns of the tunica albuginea and no protein expression for TGF-beta1, TGF-beta2, or TGF-beta3. In conclusion, TGF-beta1 protein expression is significantly associated with Peyronie's disease and may be a direct cause for its development. This finding may be of help in the prevention and treatment of this disease.

Objective: To test the effect of wogonin on cellular proliferation and expression of monocyte chemoattractant protein 1 (MCP-1) in cells derived from normal and diseased tunica albuginea (TA), as related to Peyronie's disease (PD)., Materials and Methods: Cells with characteristics of fibroblasts were isolated from three tissue sources. Those from the plaque of patients with PD were designated as P cells, those from the adjacent, normal-appearing tissue as C cells, and those from the TA of patients without PD as N cells. These cells were treated with wogonin at doses of 0, 10, 20 and 40 micromol/L for 24 h or treated at a fixed dose of 40 micromol/L for 1, 8 and 24 h. Cell proliferation was assayed with a commercial kit, MCP-1 mRNA expression by reverse transcription-polymerase chain reaction, and secreted MCP-1 by enzyme-linked immunosorbent assay., Results: Wogonin suppressed cell proliferation in a dose-dependent manner; the effect was more pronounced against P cells at 8 and 24 h. Wogonin down-regulated MCP-1 mRNA expression, especially in P cells. Wogonin suppressed the level of secreted MCP-1 by 59-88%. P cells, which secreted far more MCP-1 than N and C cells at 1 h, were suppressed by 88%. C cells were the least suppressed at all three times., Conclusions: Wogonin suppressed the proliferation, the expression of MCP-1 mRNA, and the expression of secreted MCP-1 in TA-derived cells. In most cases, the effect of wogonin was greatest against cells derived from the plaque. Wogonin appears to be a worthy candidate for preclinical trials in men with PD.

Peyronie's disease is a medically and surgically challenging condition to manage. Most surgical techniques to correct the penile deformity often shorten the penis and do not address the issue of hourglass deformity when present. We describe our indications, rationale and technique for the use of a saphenous vein graft after a curvature correcting plaque incision. In reviewing multiple series, this approach yields similar results-incidence of residual curvature: 4-20%, decreased potency: 5-20%, penile shortening: 17-40%. While harvesting the vein would require a second incision, the use of autologous vein appears to be associated with the least amount of intracavernosal fibrosis. We propose that saphenous vein is currently the best material available for tunical patching. The technique and results of circular venous grafting for patients with severe penile shortening secondary to Peyronie's disease is also discussed.

Peyronie's disease remains one of the most perplexing diseases in urology. With continued basic research in wound healing and scarring, the understanding and management of this frustrating disease will improve. Initial treatment of Peyronie's disease should be conservative, with expectant therapy and medical management. Once the penile curvature and plaque have stabilized, patients with severe deformity can be offered surgery depending on their symptoms and complaints. Patient selection is the key to proper treatment. Less experienced surgeons should limit themselves to medical management or simple surgical management of the disease, including plication or Nesbit procedures. Penile-lengthening procedures or the placement of complicated penile prosthesis should be reserved for surgeons with familiarity and expertise in this type of reconstruction. Education on the pathogenesis and natural history of the disease will allow the patient and his partner to make an informed decision in regards to treatment options and expected outcomes.

Purpose: In the present study, we tested the hypothesis that microsatellite alterations (MSI) and loss of heterozygosity (LOH) are associated with Peyronie's disease. To test this hypothesis, we analyzed samples from patients with Peyronie's for MSI and LOH on chromosomes 3, 8 and 9 using 20 different genetic markers., Materials and Methods: DNA was isolated from the penile fibrotic plaque, amplified using PCR, and analyzed for MSI and LOH on chromosomes 3, 8 and 9 using 20 different polymorphic markers (D3S1228, D3S1298, D3S1560, D3S1745, D3S2396, D3S647, D8S133, D8S255, D8S259, D8S260, D8S262, D8S285, D8S298, D8S507, D8S528, D9S162, D9S171, D9S1747, D9S1748, and D9S273). Only 10 primers (D3S1560, D3S647, D3S1298, D8S262, D8S260, D8S528, D9S171, D9S1747, D9S273 and D9S1748) showed MSI and LOH in Peyronie's samples. Microsatellite alterations and LOH were analyzed by a PCR-based technique developed in our laboratory., Results: This study demonstrates a high frequency of MSI and LOH in Peyronie's disease. Fourteen of 35 cases (40%) showed MSI at a minimum of one locus, 6 of 35 cases (17%) at a minimum of 2 loci and three of 35 (8.5%) cases at three or more loci. D9S273 locus showed highest MSI when compared with other loci examined in this study. For LOH, 14 of 35 cases (40%) were observed at a minimum of one locus, 5 of 35 cases (14%) at minimum of two loci and one out of 35 cases (2.8%) showed LOH at three or more loci. The D3S1560 and D9S171 loci showed highest LOH when compared with all other loci examined in this study., Conclusion: This is the first report demonstrating that a high frequency of MSI and LOH is associated with Peyronie's disease, suggesting their role in the pathogenesis of this disease.

Purpose: We have developed an animal model of Peyronie's disease by injecting transforming growth factor beta (TGF-beta) into the rat penis. Our objective is to study the effects of colchicine on the Peyronie's condition in an animal model., Materials and Methods: Thirty-six adult male Sprague-Dawley rats received TGF-beta injections into the tunica albuginea and were divided into two groups (n = 18 each). Rats in the first group were divided into three subgroups (n = 6 each). Each rat in the three subgroups received the following: Subgroup 1 received colchicine, subgroup 2 received ibuprofen, and subgroup 3 received regular water. The rats were euthanized after 6 weeks. Rats in the second group were also divided into three subgroups. These rats received the same treatments as the rats in the first group, but treatments began 6 weeks after TGF-beta injection. These rats were euthanized after 12 weeks. Tunical tissue samples were collected and examined using Hart and trichrome stains, electron microscopy (EM), and western blot analysis for TGF-beta detection., Results: In the first group, the colchicine-treated rats exhibited less collagen deposition and less elastic fiber fragmentation than the untreated or ibuprofen-treated rats. EM confirmed the results and showed normal distribution and shape of both collagen and elastic fibers in the colchicine-treated group. In the second group, the colchicine-treated rats exhibited less crowding of the collagen fibers. However, the elastic fibers remained fragmented and scarce. Western blot analysis showed significant down-regulation of TGF-beta expression (5/6) in the colchicine-treated group after 6 weeks. Down-regulation was observed in only 1/6 in both ibuprofen and non-treated groups. After 12 weeks 2/6, 1/6, and 1/6 rats displayed down regulation in the colchicine treated, ibuprofen treated, and non-treated groups, respectively., Conclusion: Early colchicine treatment may suppress a Peyronie's like condition in the rat animal model.

Purpose: We evaluated the results of chronic intermittent stretching with a vacuum erection device after circumferential tunical incision and circular venous grafting in 4 patients with penile shortening from severe Peyronie's disease., Materials and Methods: We performed complete circumferential tunical incision and covered the defect with a circular venous graft in 4 patients with shortened penis as a result of Peyronie's disease. Preoperative evaluation included determination of patient and partner expectations, potency status, measurement of penile length after intracavernous injection and color duplex ultrasonography to determine possible vascular communication. Lower saphenous, upper saphenous and deep dorsal veins served as graft materials. We advised patients to use a vacuum device on a daily basis for 6 months starting 1 month after surgery. Postoperative evaluations were done at 6 and 18 months postoperatively., Results: At 6-month followup 1 patient who did not use the vacuum device gained 1 inch in penile length and was not available for further followup. The other 3 patients each gained 2 inches but had decreased erectile rigidity due to narrowing in the grafted area (hourglass deformity). One patient who wanted a more natural erection elected penile prosthesis implantation about 1 year after grafting. The remaining 2 patients gained 3 inches at 18-month followup and regained partial penile rigidity similar to preoperative erections when the hourglass deformity improved. All patients were satisfied and indicated that surgery improved psychological well-being as well as relationships with partners., Conclusions: The results in this small group are satisfactory. Our technique offers a reasonable solution for correction of penile shortening in patients with Peyronie's disease.

Purpose: We describe our technique of plaque incision and venous patch grafting to correct complex penile deformity associated with Peyronie's disease., Materials and Methods: Graft material is obtained from the lower and upper saphenous and deep dorsal veins. The configuration, size and number of tunical incisions depend on the site and size of the lesion. In most cases an H-shaped tunical incision is adequate to release the contracture. With the aid of a vascular stapler several vein segments can be assembled easily into 1 piece to cover the defect., Results: The incidence of penile shortening and erectile dysfunction, following other corrective procedures, is lessened with the tunical incision and venous grafting technique., Conclusion: The venous graft provides an anatomical and functional tunical substitute. Results in correction of Peyronie's disease are highly encouraging.

Purpose: We evaluate the results of tunical incision and venous patch grafting for correcting penile deformity in Peyronie's disease., Materials and Methods: In 113 [corrected] patients with symptoms of Peyronie's disease for more than a year indications for surgery included penile shortening, persistent pain, severe curvature, penile narrowing or indentation and/or failure of previous surgery. Preoperative evaluation included determination of patient and partner expectation, potency status, circumcision status, measurement of penile length (short and long side) and saphenous vein, and color duplex ultrasonography to evaluate possible accessory vascular communication. Patients underwent plaque incision and venous patch grafting. The configuration, size and number of tunical incisions depended on the size and shape of the lesion. Lower and upper saphenous, and deep dorsal veins served as the graft materials. Postoperative followup was as long as 18 months., Results: In 96% of patients the penis became straight, while residual curvature was 30 degrees in 3% and 15 degrees in 1%. In 94% of patients narrowing and indentation were absent and in 83% penile length was the same or longer postoperatively. Of the patients who were potent preoperatively 88% experienced the same or better erectile quality after surgery. In 10% of cases a change in sensation occurred lasting longer than 6 months. Overall satisfaction was expressed by 92% of men who believed that surgery improved the psychological state as well as the relationship with the partner., Conclusions: The results are satisfactory and this procedure offers a reasonable solution for correction of Peyronie's disease.

Objective: To determine the role of transforming growth factor beta (TGF-beta), one of the cytokines known to induce tissue fibrosis, in the induction of a Peyronie's-like condition, and to produce an animal model for the further study of Peyronie's disease., Materials and Methods: Twenty-four adult male Sprague-Dawley rats were divided into two groups: in group 1, different concentrations of cytomodulin, a synthetic heptapeptide with TGF-beta-like activity, were injected into the tunica of each of 18 rats and six rats group 2 received saline injections as a control. The tunical tissues were taken after 3 days, 2 and 6 weeks and were examined histologically using Hart and trichrome stains. Electron microscopy was used to examine the ultrastructural changes in the same tissue samples., Results: There were histological and ultrastructural alterations in 15 of 18 rats in group 1 (cytomodulin-injected), especially in tissue examined after 6 weeks. The most prominent histological changes were chronic inflammatory cellular infiltration, focal and diffuse elastosis, thickening, disorganization and clumping of the collagen bundles. The ultrastructural changes were in the form of densely packed collagen, fragmented and scarce elastic fibres, separation of neuronal fibres by interposing clumps of packed collagen, and perivascular collagen deposition as a part of the reorganization of the interstitial matrix., Conclusion: Cytomodulin can induce a Peyronie's-like condition in the rat penis, which may explain the role of TGF-beta in the pathogenesis of Peyronie's disease. With further refinement, such rats may be used as an experimental model for studies of Peyronie's disease.

Purpose: Transforming growth factor beta (TGF-beta) is involved in numerous vital processes including tissue fibrosis. Our objective was to study the role of TGF-beta in the induction of a Peyronie's-like condition and to produce an animal model for the further study of Peyronie's disease., Materials and Methods: Twenty-four adult male Sprague-Dawley rats were divided into two groups. Different concentrations of cytomodulin, a synthetic heptopeptide with TGF-beta-like activity, were injected into the tunica of each rat from the first group (n = 18). Rats in the second group (n = 6) received saline injections as a control. The tunical tissues were taken after 3 days, 2 weeks, and 6 weeks and were examined using Hart and Trichrome stains. In the same tissue samples, TGF-beta mRNA and protein expression were studied., Results: Histological alterations were observed in 15 out of 18 cytomodulin-injected rats, especially in tissue examined after 6 weeks. The most prominent changes were chronic cellular infiltration, focal and diffuse elastosis, thickening, disorganization and clumping of the collagen bundles. Results from immunoblot revealed remarkable TGF-beta1 protein expression in all the cytomodulin-injected rats only after 2 and 6 weeks. No remarkable TGF-beta2 or TGF-beta3 protein expression was observed. TGF-beta1 mRNA expression in the cytomodulin-injected rats was noticed in rats injected with higher concentrations after 3 days, while it was expressed in all rats after 2 weeks. There was no expression in the control group after either 3 days or 2 weeks., Conclusions: Cytomodulin can induce Peyronie's-like condition in the rat penis, which may explain the role of TGF-beta in the pathogenesis of Peyronie's disease.

Purpose: Transforming growth factor-beta (TGF-beta) has been implicated in many chronic fibrotic conditions such as pulmonary and hepatic fibrosis. We postulated that TGF-beta may play a role in the pathogenesis of Peyronie's disease., Materials and Methods: Tissues from the tunica albuginea of 30 Peyronie's disease patients (study group) and from 6 patients without Peyronie's disease, who had undergone penile prosthesis surgery for organic impotence (control group), were subjected to histological examination using Hart and trichrome stains and Western blotting for the detection of TGF-beta protein expression., Results: The results of these experiments demonstrate that all tissue from Peyronie's disease patients showed a variety of histological changes of the tunica, ranging from chronic inflammatory cellular infiltration to complete calcification and ossification of the tissues. The most prominent changes observed in the majority of patients were focal or diffused elastosis, fenestration and disorganization of the collagen bundles. TGF-beta1 protein expression was detected in 26 patients (86%), while only 7 (23%) and 5 (17%) patients showed TGF-beta2 and TGF-beta3 protein expression, respectively. One patient in the control group showed fibrosis of the tunica albuginea and protein expression of TGF-beta1 and TGF-beta2. This patient had undergone surgery for the revision of his prosthesis twice. Five patients from the control group showed normal histological patterns of the tunica albuginea and no protein expression for TGF-beta1, TGF-beta2 and TGF-beta3., Conclusions: TGF-beta1 protein expression is significantly associated with Peyronie's disease, which may provide a new insight and the potential for the prevention and treatment of this disease.

Purpose: We studied the fine architecture of the tunica albuginea of the penis., Materials and Methods: The study included 6 human male cadavers and 10 surgical patients (5 with Peyronie's disease and 5 with normal penile anatomy)., Results: The tunica albuginea of the corpora cavernosa is a bi-layered structure with multiple sub layers. Inner layer bundles support and contain the cavernous tissue and are oriented circularly. Radiating from this layer are intracavernous pillars acting as struts, which augment the septum and provide essential support to the erectile tissue. Outer layer bundles are oriented longitudinally. These fibers extend from the glans penis to the proximal crura, where they insert into the inferior pubic ramus. There are no outer layer fibers between the 5 and 7 o'clock positions. Elastic fibers normally form an irregularly latticed network on which collagen fibers rest. In Peyronie's disease the well ordered appearance of the collagen layers is lost: excessive deposits of collagen, disordered elastic fibers and fibrin are found within the region of the plaque., Conclusions: The normal 3-dimensional structure of the tunica affords great flexibility, rigidity and tissue strength to the penis, which are lost consequent to structural changes in Peyronie's disease.

Objective: To investigate whether changes in the structure of the tunica albuginea influence the development of erectile dysfunction., Patients and Methods: Biopsy specimens taken from the tunica of 64 patients (both potent and impotent) with and without Peyronie's disease were evaluated. Tissue samples were stained and examined under light and electron microscopy, and the concentration of elastic fibres present in each was measured using computerized image analysis., Results: The concentration of elastic fibres was lower in impotent than in potent patients (P = 0.0365) and was also significantly less in patients with Peyronie's disease. Furthermore, the concentration of elastic fibres decreased with age. Electron and light microscopy revealed the presence of distinct alterations in the tunica albuginea in impotent patients and patients with Peyronie's disease that might interfere with function., Conclusion: The decrease in elastic fibre concentration and changes in microscopic features may contribute to erectile dysfunction by impairing the veno-occlusive function of the tunica albuginea.

Objectives: The treatment of Peyronie's disease with oral or topical agents has not been entirely satisfactory. In this pilot study, we hypothesized that colchicine, known to induce collagenase activity and decrease collagen synthesis, might be an ideal agent in the treatment of Peyronie's disease., Methods: Colchicine was administered orally for 3 to 5 months to a group of 24 previously untreated patients with Peyronie's disease., Results: Peyronie's plaque decreased or disappeared in 12 of the 24 patients, 7 of 9 patients with painful erections reported significant relief, and penile curvature was improved in 7 of 19 cases. Erectile status, narrowing of the penis, and accompanying Dupuytren's contracture did not change in any of the cases., Conclusions: Although this pilot study shows some promising results of the use of colchicine in the treatment of Peyronie's disease, the ultimate usefulness of this agent will be determined only by a prospective double-blind clinical study.

We describe our experience with plaque excision and placement of a venous patch graft. Sprague Dawley rats (n = 20) underwent excision of a wedge of tunica albuginea with the defect covered by a segment of detubularized femoral vein, endothelial side towards the cavernous tissue. Erectile function, as determined by the rise in intracavernous pressure with cavernous nerve stimulation (mean 54.0 +/- 4.2 cm. H2O), was equal to that in a group of 10 intact age-matched controls (mean 46.9 +/- 3.37 cm. H2O). Penile cross-sections stained with Hart's elastic fiber stain or Trichrome stain revealed only minimal fibrosis in the region of the patch. In 3 dogs, a wedge of tunica was removed, and the defect was covered with a segment of detubularized deep dorsal vein. When sacrificed at 3 months, all animals had retained their erectile function with histologic evidence of minimal fibrosis. On the basis of histologic and functional data, the venous patch appears to be a reasonable alternative substance to those in common use.

We evaluated 93 patients with complaints of sexual dysfunction and evidence of Peyronie's disease. Duplex ultrasonography (10-MHz probe and 4.5-MHz pulsed Doppler test) in 87 enabled definition of their penile vascular response to an intracorporeal injection of a vasoactive agent. Vascular disease was present in 70 percent of the study population. Forty-four patients had a surgical procedure. Nineteen had plications using a simultaneous pharmacological erection, 3 had dermal grafts, and 3 with severe vascular disease had primary placement of a prosthesis. One patient underwent a single Nesbit procedure. In 18 patients, we incised the plaque and grafted a segment of the deep dorsal vein, using the expertise gained from penile venous surgery. In the vein-grafted patients, rapid return of suppleness of the penile shaft, use of only a single incision, and use of the patient's own tissue, with the possible beneficial effect of endothelial-derived substances (nitric oxide) decreasing the risk of hematoma below the graft, support our belief that this modified technique may be superior to those presently in common use.

We describe a procedure for ablation of Peyronie's plaque using the carbon dioxide laser, which allows one to remove all palpable evidence of plaque while at the same time avoiding the creation of a large defect in the tunica albuginea requiring coverage with a large graft. The plaque is removed by making either a longitudinal or transverse incision in the plaque with a focused carbon dioxide laser beam from a hand held probe, and evaporating the plaque substance from the undersurface by tangentially directing the laser beam. It is possible to remove large dystrophic calcifications from within the plaque and to augment the repair in the area of greatest curvature using the deep dorsal vein as a patch graft. In cases of narrow plaques relaxation incisions and venous patch grafting alone are usually sufficient to correct the deformity. Our experience with 12 patients is summarized and 2 cases are reported in detail to illustrate the versatility of the procedure.