Chapter 13 - Excision and patch grafting

Abstract

Peyronie’s disease is characterized by penile deformity, sexual dysfunction, and psychological bother. Penile straightening remains the most rapid and reliable treatment for bothersome penile curvature. Mild to moderate deformity may be managed with penile plication. In the setting of severe deformity such as curvature >60 degrees or significant indentation/hourglass (with resultant penile instability or “hinge-effect”), incision or partial plaque excision and grafting may be indicated. Preoperative erectile function assessment is mandatory, and in the setting of severe erectile dysfunction, penile prosthesis placement with concurrent straightening maneuvers should be strongly considered. A variety of autologous and non-autologous graft materials are available and to date no strong data exists to suggest the superiority of one graft material over another. Synthetic grafts should be avoided. Postoperative outcomes in the appropriately selected patient are excellent, although risks including erectile dysfunction, penile sensory changes, penile shortening, and persistent or recurrent curvature must be discussed during preoperative counseling. Postoperative rehabilitation with phosphodiesterase-5 inhibitors and penile traction therapy are important adjunctive therapies. Further study is needed to determine the optimal operative approach and graft material that maximizes patient satisfaction.