Penile Extra-Tunical Graft Reconstruction of Peyronie's Disease Concavity Deformities

Abstract

ABSTRACT Introduction The extra-tunical grafting (ETG) procedure was recently introduced by UCSF investigators as a tunica-sparing technique for management of penile concavity deformities. Objective We report our initial experience with the ETG procedure. Methods We retrospectively reviewed clinical records of patients who underwent ETG at our tertiary-care referral center between 2017-2020. A collagen graft made from bovine pericardium (Lyoplant®) was placed overlying the defect without violating the tunica albuginea or mobilizing the neurovascular bundle. The stretched penile length (SPL) and circumference at the location of deformity were measured intra-operatively. Patient reported outcomes including overall satisfaction, graft palpability, and change in erectile function were evaluated by an anonymous ten-question online survey. Results Nineteen men underwent ETG during the study period and had a median follow-up of 59 (IQR: 24 - 708) days. ETG was performed via either a window (15/19, 78.9%) or a de-gloving (4/19, 21.1%) incision with concomitant penile plication performed in 16/19 (84.2%) patients. Penile circumference increased by an average of 1.37 cm ± 0.53 (p = 0.03) at the location of deformity; pre- and post-operative SPL were similar (14.0 ± 1.4 vs. 14.0 ± 1.3 cm, p = 0.95). Fifteen patients (78.9%) responded to the online survey at an average of 240 days after surgery. Overall patient satisfaction was reported by 13/15 (86.7%) patients. Twelve out of 15 (80%) patients reported concavity deformity to be improved, with 73.3% reporting the deformity to be “much better” (Figure). One patient (5.3%) reported penile hypoesthesia/decrease in sensation. An improvement in erectile function was reported in 11/15 (73.3%) patients. Two of 15 (13.3%) patients noted no change in erectile function and 2/15 (13.3%) reported a decrease in erectile function. Of the 8 patients that had follow up greater than six months after surgery, graft palpability was reported in 4/8 (50%) patients but was not bothersome. Conclusions The ETG procedure appears to be safe and effective for the treatment of penile concavity deformities. Patient outcomes and satisfaction are favorable at intermediate follow-up. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast