Abstract
Abstract Introduction Peyronie’s disease (PD) is a benign andrological condition that affects mens sexual health. Penile pain, plaques, and shaft curvatures leading to length loss and difficulties in sexual intromission are its hallmark clinical features. Although multiple surgical techniques have been explored in the management of PD, plaque incision/excision and grafting (PIG/PEG) has been described as a feasible option for more severe curvatures. Many graft materials have been explored for PIG/PEG. However, buccal mucosal grafts (BMG) have emerged as a popular, successful, and reliable choice. Objective This systematic review and meta-analysis evaluates PIG/PEG with BMG as a surgical treatment for Peyronie's disease. The outcomes of interest explored were: 1) Penile curvature 2) Erectile function (IIEF-5), and 3) Stretched penile length (SPL). 4) Post-operative functional penile straightening (<20 degrees), and 5) De novo erectile dysfunction. Methods Multiple major databases were thoroughly searched, and all relevant literature, excluding systematic reviews, meta-analyses, case reports, and abstracts, were screened. The outcomes of interest described above were extracted from the eligible studies. Data collection and analysis were done in Microsoft Excel and R Studio, respectively. A proportions and mean differences meta-analysis was supplemented with heterogeneity and publication bias tests. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the eligible studies. A p-value of <0.05 was considered statistically significant. Results Ten publications were eligible for a systematic review, which encompassed data from 226 patients. The studies were mainly observational in design and published between 2005 and 2021 in three different languages (English, Chinese, and Russian). All studies demonstrated promising outcomes for PIG/PEG with BMG. A meta-analysis of mean differences demonstrated a peri-operative curvature reduction of -49.6 degrees (95% CI: -64.4 to -34.9, p < 0.01), IIEF-5 score improvement of 4.45 points (95% CI: -0.07 to 8.9, p =), and SPL preservation with an estimated mean difference of 1.41 cm (95% CI: 0.38 to 2.44, p < 0.01). Further proportional meta-analysis of functional penile straightening and de novo post-operative erectile dysfunction demonstrated pooled estimates of 92% and 7.5%, respectively. Heterogeneity was noted to be significant among the studies. Conclusions Buccal mucosa is a viable, effective, and safe graft option for PIG/PEG in managing PD. Overall, the available literature demonstrates promising results. Despite these positive outcomes, and given the fact that all available literature includes observational studies, there is a unanimous concurrence amongst the urological guideline panels and expert bodies such as the European Association of Urology (EAU), American Urological Association (AUA), Canadian Urological Association (CUA), and European Society for Sexual Medicine (ESSM) that randomized controlled trials are essential to further support these findings and define its benefits, risks and more importantly long-term outcomes. Disclosure No.
Published Version
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