133 Long-term results after partial plaque excision and grafting with collagen fleece in Peyronie's disease

Abstract

INTRODUCTION AND OBJECTIVES: Grafting procedures are preferred for the surgical treatment in advanced Peyronie’s disease (PD) to avoid penile shortening. Autologous and non-autologous grafts are available for defect closure of the tunica albuginea after partial plaque excision or incision. Today, non-autologous grafts are widely used to reduce morbidity. We report long-term results of a prospective study analyzing the outcomes after partial plaque excision and grafting with a self-adhesive collagen fleece. METHODS: PD patients with penile deviation in stable disease and unable to fulfil coitus were included in this study at two institutions. After partial plaque excision, grafting was performed in all cases with a ready-to-use collagen fleece coated with tissue sealant (TachoSil , Takeda, Berlin, Germany). Results of correction were documented intraoperatively by artificial erection. Preand postoperative evaluation consisted of IIEF-5, penile length, sonography and artificial erection. RESULTS: From December 2004 to July 2013 n1⁄4290 patients underwent surgery. Mean patient age was 57.0 years (range: 33-73). 87.6% of patients had dorsal deviation and 12.4% lateral or ventral deviation. In 244/290 patients (84.1%) a partial plaque excision with collagen fleece grafting was performed. 46/290 patients (15.9%) underwent a Nesbit-procedure. Mean operating time was 80.8 minutes (range: 60-165) in patients with a grafting procedure. Totally straightness of the penis was achieved in 238/244 (97.5%) patients. After a mean long-term follow-up of 36.8 months (range: 3-100), erectile function improved in 23.3%, remained unchanged in 66.0%, and worsened in 10.7% of patients. Mean penile length before and after surgery was 14.3 cm (range: 6-21) and 15.0 cm (range: 8-22), respectively. 230/244 patients (94.3%) had normal glans sensibility. CONCLUSIONS: Grafting by a ready-to-use collagen fleece following partial plaque excision in PD is safe and successful. Longterm results are encouraging. A major advantage of the collagen fleece is reduced operating time and its easy application. Moreover an additional haemostatic effect is provided. The collagen fleece represents a feasible alternative to other grafts for PD reconstructive surgery.