Tunica Albuginea Defect Research Articles

(018) Long Term Outcome of Tachosil Patching of the Penile Tunica Albuginea Defect in the Dog: Histological and Hemodynamic Results

Abstract Introduction The need for patching of the penile tunica albuginea (TA) might arise during surgery for Peyronie’s disease with or without a penile prosthesis. Clinically, TachoSil has evolved as an off-the-shelf hemostatic graft that does not need suturing. Results in patients are encouraging. However, its histopathological fate and its impact on the hemodynamics of erection are not known. Objective We evaluate the long-term histopathology and pharmacologically induced erection after Tachosil patching of the TA in dogs. Methods Under general anesthesia, the penis of two adult male beagle dogs was dissected through a midline incision, and TA was exposed. The femoral artery was cannulated and connected to an invasive pressure monitor to record BP. Intracavernous pressure (ICP) was measured on each cavernous side separately, as a complete septum isolates the two compartments of the penis. A 21-gauge butterfly needle was placed on either side proximally. Five minutes were allowed before taking baseline ICP. Ten mg of papaverine hydrochloride was injected intracavernosal. ICP was measured at 2 to10-min time points. On the left side, 2 cm proximal to the glans of the penis, a full-thickness defect was created in TA 1 cm long and 0.5 cm wide (Fig. 1. A, B &C). Four transverse incisions 1 cm long were made on the right side and placed 0.5 cm apart, exposing the corpus cavernosum (Fig. 1. D). A Tachosil patch (Takeda, Japan) was fashioned and applied to cover the defects. Proline 5/0 sutures were placed, marking the proximal and distal ends of the graft areas. The fascia, subcutaneous tissue, and skin were closed with absorbable sutures. Six months later, each dog was anesthetized, and the penis was dissected free from the covering fascia. Invasive BP and ICP measurements were repeated at baseline and after 10 mg papaverine injection. Silk and proline sutures were placed to identify the distal end and the left side of the penis. The penis was excised from the base of the glans penis distally to its root, at least 6 cm proximally and fixed in 10% formaldehyde solution. Transverse blocks of the penis were cut at 3 mm intervals and fixed in paraffin. Sections from each block were stained with H&E and trichrome and examined by a urology pathologist. Descriptive statistics are provided. Results Gross appearance showed a well-healed scar, and the subcutaneous tissue did not show significant adhesions. The graft site was impossible to distinguish, and the sutures were not visible. ICP measurement did not show a drop in pressure pre- and post-surgery (Fig. 2). Histologically, minimal foreign body reaction was seen, and the tunica albuginea was completely regenerated (Fig. 3). The underlying cavernous tissue did not show inflammation or necrosis. Conclusions Long-term histological results of Tachosil patching in the dog show complete tunica albuginea regeneration with minimal tissue reaction and no underlying cavernous tissue pathology. Hemodynamically the intracavernous pressure response to papaverine is maintained. Although only two animals are presented here, the results are striking. Further experimentation with more animals is warranted to support these findings. Disclosure No.

Current concepts of Peyronie’s disease (clinical lecture)

The article is presented in the format of a lecture. Peyronie’s disease (induratio penis plastica) is a progressive fibrotic disorder of the penile tunica albuginea that results in fibrotic penile plaques and can cause penile deformity. The issues of etiology, pathogenesis, clinical picture and diagnosis of Peyronie’s disease (PD) are reviewed in the lecture from the modern points of view. PD is frequently associated with penile pain, erectile dysfunction, and a secondary anxiety-depressive state. Despite the existence of this problem for several centuries, no unified concept of the Peyronie’s disease pathogenesis can be found in literature. A growing amount of research has shown that PD is a chronical disorder of local wound healing process within the tunica albuginea and the Smith’s space. Over the past 40 years, multiple lines of evidence have pointed to a genetic factor that predisposes some men to the development of Peyronie’s disease. Treating men with PD remains a challenging problem for clinicians working in urology. Given the high prevalence of PD and its significant impact on affected men, its better understanding is essential. Treatment methods for PD are varied and include oral, local, intralesional and traction therapy, and surgical treatment. Current clinical care standards for PD are aimed at the symptom suppression, as there are currently no treatment for PD that can eliminate its causes or progression. Clostridium histolyticum collagenase has shown its effectiveness in treating PD, but its efficacy and safety remain controversial. Surgery remains the most effective method for PD treatment and is considered to be “gold standard”. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients’ expectations and surgeon’s preferences. Various surgical techniques and grafting materials (autologous and non-autologous) can be used for the coverage of the tunica albuginea defect after partial plaque excision or incision.

A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals.

A penile tunica defect may arise during surgery in patients with Peyronie's disease. Collagen fleece (TachoSil) has recently gained popularity in penile surgery to cover the tunica albuginea (TA) defect associated with clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. We aimed to study the histopathology of the TachoSil graft in an experimental animal model for the regeneration of TA, inflammation, fibrosis, and the underlying cavernous tissue. Six adult male Sprague Dawley rats were used. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1 mm × 10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect. The penile skin covering was then restored. At 2 months, the rat penis was excised and examined with hematoxylin, eosin, and trichrome stains. We conducted a literature review of penile grafts in animals for comparison. Rats weighed 369.2 gm (standard deviation: 31.5). At 2 months, all rats showed normal-looking penis with complete healing, no scaring, tethering, or gross inflammatory features. Histopathology of the patch site showed fibrosis, chronic inflammation, and foreign body giant cell reaction. There was no generation of a new TA, or new vascularity. No inflammatory or pathological reaction affected the underlying corpus cavernous tissue. One rat died on the 6th postoperative day. Postmortem showed massive multiorgan hemorrhage consistent with disseminated intravascular coagulopathy (DIC). Unlike some other reported grafts, there is no TA regeneration. TachoSil patching of penile TA defect forms a distinctive barrier against inflammation, protecting the underlying corpus cavernosum. However, no regeneration of the tunica defect is observed at 2 months. DIC is a potential complication of systemic absorption of TachoSil.

(112) An Experimental Animal Study of the Histopathological Effect of Collagen Fleece (TachoSil) Patch of Tunica Albuginea Defects Associated with Penile Surgery

Abstract Introduction A penile tunica defect may arise during penile prosthesis surgery or reconstruction of the penis in patients with Peyronie’s disease. Collagen fleece (TachoSil) was recently reported in penile surgery to cover the tunica defect with reported clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. Objective We study the novel application of TachoSil graft in an experimental animal model. We looked at the regeneration of tunica albuginea, development of inflammation and fibrosis, and histopathological effect on the underlying cavernous tissue. Methods Seven adult male Sprague Dawley rats were used. All procedures were carried out under general inhalation anesthesia. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1x10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect in six rats and Surgicel (Ethicon) in one. The penile skin covering is then restored and fixed with interrupted 5-6 zero absorbable sutures. At two months, the rat penis was evaluated for excision. Euthanasia was carried out with an overdose of inhalation anesthesia and chest opening. The excised penis was examined by hematoxylin and eosin and trichrome stains. Results At the time of surgery, the rats’ weight was 390 gm (SD 33.8). All rats with TachoSil showed normal-looking penis at two months with complete healing, no scaring, tethering, or gross inflammatory features. The penis of three rats with a Tachosil patch was harvested at two months postoperatively. It showed histopathology of fibrosis, chronic inflammation, and foreign body giant cell reaction at the site of the patch. There was no generation of a new tunica albuginea, no new vascularity or distinct fibrous layer development. The underlying corpus cavernous tissue was not affected by any inflammatory or pathological reaction. One rat died on the 6th postoperative day. Postmortem showed massive gastrointestinal bleeding, intraperitoneal hemorrhage, and punctate hemorrhages of the parenchyma of both suprarenal glands, both kidneys, and the liver. A clinical diagnosis of DIC was made. Histopathology of the penis, however, did not show micro thrombosis. The fifth rat with a Surgicel patch showed immediate hematoma of the penis controlled by compression. After two months, during harvesting of the penis, large pockets of pus were seen spreading from the site of the patch to surrounding structures. Histopathology showed chronic inflammation and fibrosis extending into the corpus cavernosum. The sixth and seventh rats showed normal penis external appearance at two months and were left surviving for harvest at four months. Conclusions Tachosil patching of penile tunica albuginea defect forms a distinctive barrier against inflammation protecting the underlying corpus cavernosum. However, no regeneration of tunica defect is observed at two months. DIC is a potential complication of systemic absorption of TachoSil. Disclosure No

English

BACKGROUND Penile fractures occur when the engorged penile corpora are forced to buckle and “pop” under the pressure of a blunt sexual trauma, due to slippage of the penis out of the vagina during intercourse. Patients typically describe that a “plop” sound was followed by immediate de-tumescence, severe pain, and swelling, called as “egg-plant” deformity, as a result of the injury. The immediate surgical exploration with evacuation of the haematoma and repair of tunica albuginea defect is the ideal treatment. METHODS Over a period of more than 3 years between May 2015 and January 2019 we have treated 26 patients with penile fractures. All of them presented within 24 hours after sustaining the injury. None had associated urethral injury. Apart from clinical examination and history the investigation most commonly used by us to aid diagnosis was Ultrasound (USG) and colour doppler which helped in identifying the site and size of the defect as well as the blood collections. All were treated by surgical exploration. RESULTS Patients were discharged either on 2nd or 3rd post-operative day. None of our patients developed any postoperative wound infection. Post-operative hematoma developed in 01 patient. 01 patient had complaints of slight bend of the penis to the affected side but with no sexual problem. There was no history of erectile dysfunction in any of these patients. CONCLUSIONS To diagnose penile fracture, our study relied on history and physical examination mainly and did not recommend imaging, except for, in patients with possible urethral injuries. Immediate surgical intervention can make good functional results and surgical exploration can be considered in all cases of penile fractures. The procedure is simple with minimal morbidity, low morbidity and short hospital stay. KEYWORDS Fracture, Corpora, Tear

Surgical results in penile fracture: Our single center experience

Penile fracture arises as a result of a unilateral or bilateral rupture of the tunica albuginea of the corpus cavernosum. It is a rare condition that requires urgent surgical intervention. In this study, we aimed to determine the effectiveness of surgical treatment in penile fracture and its effect on complications. The data of 21 patients who were admitted to the emergency department of our clinic between 2012 and 2019 and underwent emergency surgical repair with the diagnosis of penile fracture were collected retrospectively. The diagnosis of penile fracture was established by anamnesis and physical examination. Age, etiology, duration from trauma to surgery, physical examination findings,length and localization of the tunica albuginea defect, length of hospital stay, and postoperative first-, third- and sixth-month follow-up results were analyzed. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Complications such as penile curvature, penile nodule and painful erection were evaluated. The mean age of the patients was 36.8±8.3years. The most common reason of penile fracture was manually bending the penis for detumescence. All patients underwent surgery. The mean duration from trauma to surgery was 7.6±3.1h. The mean length of the tunica albuginea defect was 11±2.5mm. The mean length of hospital stay was 2.5±0.5days. The mean IIEF-5 scores in the postoperative first, third and sixth months were 20.5±2.6, 22±2.2, 22.1±1.7, respectively. Penile fracture is a urological emergency, and timely surgery is an effective treatment method for preventing postoperative complications.

O-38 Expansion Technic: Penile Length and Girth Enlargement with Minimal Tunica Albuginea Defect Without Graft to Correct Peyronie’s Disease During Penile Prosthesis Implantation

O-38 Expansion Technic: Penile Length and Girth Enlargement with Minimal Tunica Albuginea Defect Without Graft to Correct Peyronie’s Disease During Penile Prosthesis Implantation

646 Management of traumatic rupture of the corpora cavernosa

The fracture of penis is a rare urological emergency which requires a prompt management in order to prevent late complications. We aim to study the epidemiological, clinical and therapeutic characteristics of penile fracture as well as the patients sexuality outcome after treatment. It is about a retrospective study including 73 patients who underwent surgery for fracture of penis from January 2000 to December 2016. Detailed history and clincal findings, the delay of time between fracture and management, as well as modalities of treatment were documented for each case. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. The median age of the patients was 32,6 years (interquartile range [IQR]: 19 - 50 years). 42 patients were married. The most common causes were forced manipulation of the erect penis while masturbating in 40 cases (55%) and blunt trauma during sexual intercourse in 28 cases (39%). The delay time between the fracture and consultation ranged from 1 hour to 5 days. 53 patients had presented less than 24 hours after the trauma. The symptoms reported were severe sharp pain, an expansive hematoma and penile deformity in all cases. In majority of cases (85%) the surgical approach was electively over the area of suspected fracture. The median length of tunica albuginea defect was 15 mm. Only one patient presented with Fournier gangrene immediately after surgery. Postoperative IIEF-5 scores were 21 and 23 at the first and third postoperative months, respectively. Meanwhile, 3 patients developed penile curvature, only one patient complained of sexual dysfunction and underwent a successful surgical treatment.

MP84-02 MANAGEMENT OF TRAUMATIC RUPTURE OF THE CORPORA CAVERNOSA

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-02 MANAGEMENT OF TRAUMATIC RUPTURE OF THE CORPORA CAVERNOSA Kays Chaker, Ahmed Sellami, Yassine Ouanes, Mrad Dali Kheireddine, Karem Abid, Sami Ben Rhouma, and Yassine Nouira Kays ChakerKays Chaker More articles by this author , Ahmed SellamiAhmed Sellami More articles by this author , Yassine OuanesYassine Ouanes More articles by this author , Mrad Dali KheireddineMrad Dali Kheireddine More articles by this author , Karem AbidKarem Abid More articles by this author , Sami Ben RhoumaSami Ben Rhouma More articles by this author , and Yassine NouiraYassine Nouira More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2770AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The fracture of penis is a rare urological emergency which requires a prompt management in order to prevent late complications. We aim to study the epidemiological, clinical and therapeutic characteristics of penile fracture as well as the patients' sexuality outcome after treatment. METHODS A retrospective study including 73 patients who underwent surgery for fracture of penis from january 2000 to december 2016. Detailed history and clincal findings, the delay time between fracture and management, as well as modalities of treatment were documented for each case. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. RESULTS The median age of the patients was 32,6 years (interquartile range [IQR]: 19 - 50 years). 42 patients were married. The most common causes were forced manipulation of the erect penis while masturbating in 40 cases (55%) and blunt trauma during sexual intercourse in 28 cases (39%). The delay time between the fracture and consultation ranged from 1 hour to 5 days. 53 patients had presented less than 24 hours after the trauma. The symptoms reported were severe sharp pain, an expansive hematoma and penile deformity in all cases. In majority of cases (85%) the surgical approach was electively over the area of suspected fracture. The median length of tunica albuginea defect was 15 mm. Only one patient presented with Fournier gangrene immediately after surgery. Postoperative IIEF-5 scores were 21 and 23 at the first and third postoperative months, respectively. Meanwhile, 3 patients developed penile curvature, only one patient complained of sexual dysfunction and underwent a successful surgical treatment. CONCLUSIONS The diagnosis of penile fracture includes detailed history and clinical examination. No paraclinical investigations are necessary. A normal sexuality is only insured by an early management in order to avoid late complications. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1124-e1125 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kays Chaker More articles by this author Ahmed Sellami More articles by this author Yassine Ouanes More articles by this author Mrad Dali Kheireddine More articles by this author Karem Abid More articles by this author Sami Ben Rhouma More articles by this author Yassine Nouira More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Peyronie's graft surgery-tips and tricks from the masters in andrologic surgery.

BackgroundGrafting techniques in the surgical management of Peyronie’s disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD.MethodsThis report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed.ResultsAdequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy.ConclusionsThe present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.

The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair.

To determine the accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of penile fracture and preoperative mapping for modified surgical repair. Twenty-five consecutive patients were included in the study prospectively over 29months (from February 2014 to June 2016). US examination and MRI were performed on all patients and interpreted by two expert radiologists independently. The location of the defect in tunica albuginea was mapped onto a designed scheme preoperatively using each imaging modality. The detection rate, as well as agreement between preoperative radiologic mapping and surgical outcomes, was determined for each modality. The mean age of the patients was 28±7.5years. The most common etiology was intercourse (88%). The most common location of tunica albuginea rupture was mid-shaft of the penis (60%), and the mean length of tunica defects in their greatest dimension was 13.5±3.95mm. All patients had associated hematoma, but no urethral injury was detected. The detection rate of US and MRI was 88 and 100%, respectively. US mapped the tear location correctly in 18 patients [61 out of 75 items (81%); κ=0.66], while MRI mapped it precisely in 23 patients [73 out of 75 items (97%); κ=0.95]. Both modalities are extremely helpful for the diagnosis of penile fracture. Considering the cost-efficiency and accessibility of ultrasonography, US is recommended as the first-line tool for both diagnosis and preoperative mapping. MRI may be used as a complementary study in the patients for whom US fails to visualize or precisely define the tunica defect.

Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease.

Peyronie's disease (PD) is a benign fibrotic disorder of the tunica albuginea of the penis, which can cause penile pain, curvature, shortening, erectile dysfunction, and psychological distress. Surgery is indicated when penile curvature prevents satisfactory sexual intercourse. Plaque incision or excision with grafting has been suggested as an option in patients with a penile curvature greater than 60°, a shortened penis, and/or an hourglass or complex deformity. To provide an overview of recent studies reporting outcomes of grafting techniques and to report advances in the development of new grafting materials for PD surgery. A literature review was performed through PubMed from 2011 through 2016 regarding grafting techniques for PD. Key words used for the search were grafting techniques, grafts, graft materials, Peyronie's disease, surgical outcomes, and surgical therapy. To report on novel and promising graft materials for PD and to discuss surgical techniques, outcomes, and limitations. Discussed outcomes include postoperative penile straightening, shortening, erectile function, glans sensation, and patient satisfaction. Various surgical techniques and grafting materials can be used for the coverage of the tunica albuginea defect after partial plaque excision or incision. Autologous and non-autologous grafts have been used in this setting. A major advantage of the available "off-the-shelf" grafts is that they do not require donor site harvesting, thus decreasing morbidity and operative time. Tissue-engineered grafts represent the future, but more research is needed to further improve surgical handling and postoperative outcomes. Patients opting for grafting techniques should have sufficient erectile rigidity preoperatively. Surgeon experience, careful patient selection, patient preference, and type of penile deformity affect the choice of graft and surgical approach used. Hatzichristodoulou G, Osmonov D, Kübler H, etal. Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease. Sex Med Rev 2017;5:544-552.

Grafting techniques for Peyronie's disease.

Peyronie’s disease (PD) is a benign fibrotic condition of the penile tunica albuginea. PD can be associated with penile pain, curvature, shortening, and erectile dysfunction (ED). The predominant and most bothersome symptom in affected patients is penile curvature, which can lead to inability to have sexual intercourse. In such cases, surgical correction of the curvature may be required. Plication techniques to correct curvature can cause penile shortening and therefore are generally reserved for curvatures <60°. Penile prosthesis implantation with simultaneous correction of curvature by various means is recommended in PD patients with ED not responding to medical therapy. Grafting techniques are the preferred surgical treatment in patients with penile curvatures >60°, short penis, or hourglass deformity. Patients scheduled for grafting surgery are required to have satisfactory erectile rigidity preoperatively. There are various grafting materials that can be used for closure of the tunica albuginea defect following plaque incision/excision. Both autologous and non-autologous grafts have been used for PD reconstructive surgery, and each graft has its advantages and disadvantages. Novel grafting materials are presented and discussed in this review. A major advantage of the available “off-the-shelf” grafts is that there is no harvesting from a donor site and, thus, morbidity is reduced, and operative times are minimized. Further investigations in regard to tissue-engineered grafts to improve surgical handling and postoperative outcomes are ongoing. Surgeon experience, careful patient selection, patient preference and type of penile deformity affect the choice of graft. This review summarizes the literature within the past 5 years regarding grafting techniques in PD. Surgical outcomes and limitations of grafting techniques are reported. A major objective of this review is dedicated to preoperative considerations and indications for grafting procedures, with the aim to improve surgical outcomes and increase patient satisfaction. Proper postoperative management of patients after incision/excision and grafting is important to avoid early and long-term complications and unwanted outcomes. This review provides an overview of recent advances and recommendations in regard to rehabilitation strategies after grafting procedures. Adequate preoperative patient counseling, careful patient selection, appropriate indications, and postoperative management is key to optimal surgical outcomes with high satisfaction rates after grafting techniques in PD surgery.

Delaying Surgical Treatment of Penile Fracture Results in Poor Functional Outcomes: Results from a Large Retrospective Multicenter European Study

BackgroundPenile fracture is a rare clinical entity that represents a urologic emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. ObjectiveTo determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients to investigate the impact of surgical delay on functional outcomes. Design, setting, and participantsA retrospective analysis was performed using data obtained from 137 patients presenting with penile fracture at seven different European academic medical centers between 1996 and 2013. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect, and surgical technique were recorded. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. Outcome measurements and statistical analysisThe association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. Results and limitationsThe median age of the patients was 34.50 yr (interquartile range [IQR]: 28.0–46.5 yr). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound, and 5 patients (3.64%) were evaluated with magnetic resonance imaging. All patients were treated surgically, and the duration between emergency room admission and surgical intervention was 5.0h (IQR: 3.6–8.0h). The median length of tunica albuginea defect was 10mm (IQR: 8–20mm). Postoperative IIEF-5 scores were 21 (IQR: 12–23) and 23 (IQR: 15–24) at the first and third postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed >8.23hours after emergency room admission, postoperative erectile function was significantly worse (p=0.0051 at first month and p=0.0057 at third month postoperatively). ConclusionsOur multicenter study showed that delaying surgical intervention results in significantly impaired erectile function. Surgical treatment must be planned as soon as possible to avoid postoperative erectile dysfunction. Patient summaryWe looked at sexual outcomes following the repair of penile fracture in a large European population. We found that outcomes worsened if surgical repair was delayed.

Penile fracture and its management

Fracture penis is a rare surgical emergency that is also underreported and treatment often delayed due to embarrassment felt by the patient. The condition is one of some uncommon emergencies which are fully diagnosed through history and clinical examination. Only a few cases need USG or color Doppler as a supportive tool for diagnosis. Penile fracture commonly occurs due to slippage of the penis out of the vagina during sexual intercourse. Generally patient presented to surgical emergency within 48 hours of injury can be handled successfully with minimum complications. The immediate surgical exploration with evacuation of the hematoma and repair of tunica albuginea defect is the ideal treatment. Postoperatively the patient may have erectile dysfunction, but this is self-limiting, normalising in 3-4 months.

AB024. The penile dermal flap* for defect reconstruction in Peyronie’s disease (PD) deformities

ObjectiveGenerally speaking, historically, two main types of surgical treatments have been used to straighten penis deformity in Peyronie’s disease (PD)*: viz. (I) plication procedures; and (II) assorted graft materials to close defects in the tunica albuginea after plaque/deformity excision/release. Many different techniques have been described under each category. Curiously, flaps* (cf. free grafts), which are widely used in many other surgical applications, have hardly been tried in PD. The first description of a pedicled, epidermis-free, dermal penile skin flap for covering the tunica albuginea defect after plaque incision/excision in PD was made by this author in 1992 at the Milan ISSM meeting. In 1994, at the Singapore ISSM meeting, the penile dermal flap operation was awarded the ISSM’s prestigious biennial Herbert Newman award for best paper in original clinical research in the field of sexual health. In this talk, attention is drawn to the biological and cost advantages of having and using biological auto flaps, and it’s operative technique, advantages and long term results. S. KRISHNAMURTI: ‘Penile dermal flap for defect reconstruction in Peyronie’s disease: operative technique and four years’ experience in 17 patients.’ Int J Impotence Res (1995) 7, 195-208.’ In this presentation, the operative technique in both, circumcised and uncircumcised Peyronie’s disease patients will be shown with slides and videos.MethodsOperative technique video and PPT slides to be shown.ResultsPresented in body of talk.ConclusionsWhen available, simple, autologous local pedicled flap ideal material for PD defect closure.

MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY.

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY. Giorgio Bozzini, Maarten Albersen, Javier Romero Otero, Juan Ignacio Martinez-Salamanca, Markus Margreiter, Christian Gratzke, Eduardo Garcia Cruz, Alex Mueller, Ege Can Serefoglu, and Paolo Verze Giorgio BozziniGiorgio Bozzini More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Juan Ignacio Martinez-SalamancaJuan Ignacio Martinez-Salamanca More articles by this author , Markus MargreiterMarkus Margreiter More articles by this author , Christian GratzkeChristian Gratzke More articles by this author , Eduardo Garcia CruzEduardo Garcia Cruz More articles by this author , Alex MuellerAlex Mueller More articles by this author , Ege Can SerefogluEge Can Serefoglu More articles by this author , and Paolo VerzePaolo Verze More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1051AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile fracture is a rare clinical entity, which represents a urological emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients in order to investigate the impact of delaying the surgery on functional outcomes. METHODS A retrospective analysis of the data obtained from 137 patients presenting with penile fracture from 7 different European academic medical centers between 1996 and 2013 was carried out. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect and surgical technique were recorded. Postoperative erectile function outcomes were assessed with IIEF-5 and presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. RESULTS The mean age of the patients was 38.96±13.55 (range 18–87). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound and 5 patients (3.64%) were evaluated with MRI. All of the patients were treated surgically and the duration between ER admission and surgical intervention was 13.01±0.51 (range 1.5-240) hours. The mean length of tunica albuginea defect was 15.32 ± 8.30 mm (range 7–50). Postoperative penile curvature was observed in 5/137 (3.64%) patients. Postoperative IIEF-5 scores were 15.09±7.8 and 16.85±8.96 at 1st and 3rd postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed later than 8.23 hours after ER admission, postoperative erectile function was significantly worsened (p=0.0051 and p=0.0057 at 1st and 3rd months, respectively). CONCLUSIONS Our multicentric study shows that delaying the surgical intervention for more than 8.23 hours after presentation to the ER results in significantly impaired erectile function. Therefore, surgical treatment must be planned as soon as possible in order to avoid postoperative erectile dysfunction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e214 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Bozzini More articles by this author Maarten Albersen More articles by this author Javier Romero Otero More articles by this author Juan Ignacio Martinez-Salamanca More articles by this author Markus Margreiter More articles by this author Christian Gratzke More articles by this author Eduardo Garcia Cruz More articles by this author Alex Mueller More articles by this author Ege Can Serefoglu More articles by this author Paolo Verze More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fibrin Glue for the Suture-Less Correction of Penile Chordee: A Pilot Study in a Rabbit Model

OBJECTIVE To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. MATERIALS AND METHODS Nine New Zealand white male rabbits were utilized. All had a 15 × 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 µg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. RESULTS None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 µg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. CONCLUSIONS In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.

Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model.

To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 microg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 microg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.

APPLICATION OF PERICARDIAL GRAFT IN THE SURGICAL MANAGEMENT OF PEYRONIE’S DISEASE

We investigated the use of Tutoplast cadaveric pericardium as an alternative material for grafting the tunica albuginea defect after Peyronie's plaque excision. A total of 11 patients with significant penile curvature interfering with sexual intercourse were evaluated after at least 12 months of conservative therapy. Preoperative evaluation in all cases included penile duplex Doppler ultrasound studies. Chemically processed and gamma irradiated pericardium was used to graft the cavernosal defect after surgical excision of the penile plaque. In 3 patients a penile prosthesis was simultaneously placed secondary to documented erectile dysfunction at duplex Doppler ultrasound evaluation. Penile curvature resolved in all patients, allowing for normal sexual function after a mean followup of 14 months (range 9 to 19). No postoperative evidence of tissue rejection or infection was noted. In 1 patient urethro-corporal communication developed and a single penile cylinder was explanted. Another patient had a mild dorsal bulge at the site of graft placement when the prosthesis was fully inflated. Polymeric silicone material used to provide satisfactory results in the surgical treatment of Peyronie's disease but it is no longer available for biomedical use. We demonstrate the effective use of cadaveric pericardium as a graft material for cavernosal defects after Peyronie's plaque excision. Overall patient satisfaction, absence of a second surgical incision, relative low risk and ease of surgical placement make this material ideal for the surgical treatment of this disease process.