(164) Technique of Plaque Excision and Coroporoplasty Using Free Tunica Vaginalis Graft

Abstract

Abstract Introduction Severe penile curvature causing inability to perform pleasurable sexual activity is the most dreadful sequel of Peyronie disease. Surgical plication methods have their limitations of recurrence of curvature or penile shortening which is not acceptable to patients. In cases of severely calcified plaques, excision of the plaque with grafting of the defect remains the only viable option. Several graft materials have been used for repairing the defect. We present our experience of Plaque excision and coroporoplasty using local tunica vaginalis free graft. Objective To demonstrate the technique of free tunica vaginalis free graft corporoplasty for severe curvature due to Peyronie plaque. Following steps of corporoplasty are demonstrated. Penile degloving, artificial erection and plaque demarcation, dissection of the neuro-vascular bundle, plaque excision, harvesting the tunica vaginalis graft, corporoplasty using tunica vaginalis, restoration of neuro-vascular bundle, closure of scrotal wound and completion of circumcision. Methods 7 patients between the age group of 47 to 68 years (mean age 54.6 years) were operated using this technique between 2018 to 2022. All patients had dorsal penile curvature with hard palpable plaque ranging from 2.5 cm to 5.2 cm. All patients were evaluated objectively using auto-photography. Penile doppler was done in all patients to confirm pre-operative arterial flow. Plaque exposure was done by penile degloving. Tunical graft was harvested by midline scrotal incision. Complete plaque excision was done and graft was sutured with 3–0 Prolene sutures. Results All patients had normal erectile function after the surgery. The maximum follow-up period was 42 months. All patients reported normal sexual function after a month of surgery. 2 patients complained of persistent induration and hardness at the site of graft, however the function being normal. Penile length shortening was noted in 4 patients which ranged between 4–6% of previous length, however it did not alter the sexual function. Conclusions Complete excision of the Peyronie plaque with corporoplasty using free tunica-vaginals graft is an effective, cost-effective and functionally acceptable technique for patients with hard and calcified plaque offering excellent functional outcomes. Disclosure No.