{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:53:55Z","timestamp":1770274435721,"version":"3.49.0"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T00:00:00Z","timestamp":1533254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Peyronie's Disease (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>) is an acquired connective tissue disorder that often leads to penile curvature (<jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content>) and sexual dysfunction. Penile lengthening procedures (<jats:styled-content style=\"fixed-case\">PLP<\/jats:styled-content>) with four\u2010layered porcine small intestinal submucosa graft (Surgisis<jats:sup>\u00ae<\/jats:sup><jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content>; Cook) have been widely used in patients with severe <jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content> when erectile function is preserved. However, complications such as erectile dysfunction (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) may limit treatment satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Focusing on patients perspective, our study aims to evaluate longterm patient\u2010reported outcomes, satisfaction, and dissatisfaction predictors after <jats:styled-content style=\"fixed-case\">PLP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This prospective study included 32 patients affected by <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> with severe <jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content> submitted to <jats:styled-content style=\"fixed-case\">PLP<\/jats:styled-content> with Surgisis<jats:sup>\u00ae<\/jats:sup><jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content> between 2011 and 2014. All patients were submitted to a standardized protocol with regular clinical evaluation at 3, 6 and 12\u00a0months, and yearly thereafter. After the third year follow\u2010up, <jats:styled-content style=\"fixed-case\">IIEF<\/jats:styled-content>\u20105, modified <jats:styled-content style=\"fixed-case\">EDITS<\/jats:styled-content> and an additional non\u2010validated questionnaire were completed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Concerning the surgical procedure, the mean tunical defect area (<jats:styled-content style=\"fixed-case\">TDA<\/jats:styled-content>) was 15.9\u00a0\u00b1\u00a06.9\u00a0cm<jats:sup>2<\/jats:sup>. The mean follow\u2010up time were 49.6\u00a0\u00b1\u00a012.7\u00a0months and there was a significant increase in stretched penile length (<jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.01). Postoperative erectile function as assessed by <jats:styled-content style=\"fixed-case\">IIEF<\/jats:styled-content>\u20105 was positively correlated with overall treatment satisfaction evaluated through <jats:styled-content style=\"fixed-case\">EDITS<\/jats:styled-content> (<jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.01). <jats:styled-content style=\"fixed-case\">TDA<\/jats:styled-content> was negatively correlated with postoperative <jats:styled-content style=\"fixed-case\">IIEF<\/jats:styled-content>\u20105 (<jats:italic>R\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>\u20100.56, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001). <jats:styled-content style=\"fixed-case\">TDA<\/jats:styled-content> \u2265 14.375\u00a0cm<jats:sup>2<\/jats:sup> can predict <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> with 76.9% sensibility and 58.3% specificity. Moreover, <jats:styled-content style=\"fixed-case\">TDA<\/jats:styled-content> \u2265 21.875\u00a0cm<jats:sup>2<\/jats:sup> can predict clinically significant <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">IIEF<\/jats:styled-content>\u20105 score \u226417) with 80% sensibility and 95.2% specificity. Patient\u2010reported longterm complications were 65.6% decreased penile length, 56.5% diminished rigidity and 25% curvature recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">PLP<\/jats:styled-content> using a Surgisis<jats:sup>\u00ae<\/jats:sup> <jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content> is a valuable surgical option for the treatment of <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> with severe <jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content>. Although it results in high rates of long\u2010term patient\u2010reported overall satisfaction, possible outcomes such as postoperative <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> must be acknowledged. <jats:styled-content style=\"fixed-case\">TDA<\/jats:styled-content> is a strong predictor for postoperative <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> and should be considered in clinical practice to classify patients in low\u2010 or high\u2010risk for postoperative <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.12522","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T06:23:46Z","timestamp":1533623026000},"page":"909-915","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Penile lengthening with porcine small intestinal submucosa grafting in Peyronie's disease treatment: long\u2010term surgical outcomes, patients\u2019 satisfaction and dissatisfaction predictors"],"prefix":"10.1111","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0061-5211","authenticated-orcid":false,"given":"A.","family":"Morgado","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Urologia Centro Hospitalar S\u00e3o Jo\u00e3o Porto Portugal"},{"name":"Faculdade de Medicina da Universidade do Porto Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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