Plaque Incision Research Articles

Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie's curvatures.

Collagen fleece grafting (CFG) is the recommended treatment for severe Peyronie's disease (PD) curvature (> 60°), but its efficacy in mild/moderate curvatures remains uncertain. This study evaluated CFG in patients with mild/moderate curvatures (< 60°) at risk of penile shortening or symptomatic plaque. A retrospective review was conducted on patients who underwent surgical treatment for PD using plaque incision or partial plaque excision and CFG. Clinical parameters and complications were reviewed. Subgroup analysis was performed on patients with curvatures of > 60° and curvatures ≤ 60°. 89 patients with a median age of 59years and a median curvature of 70 (20-90)° were identified. Dorsal curvature was predominant in 66% of cases, followed by lateral (16%), ventral (8%), and complex curvatures (10%). Partial plaque excision was performed in 98% of patients, with an average grafting area of 2.1cm2; 71% had a singular penile plaque, while 29% presented two or more plaques. The comparison between patients with curvatures ≤ 60° and > 60° revealed no significant differences in mean operation time (86.3 vs. 94.4min, p = 0.13) or in the incidence of postoperative complications, including glans necrosis, hypoesthesia, ecchymosis, bleeding, hematoma, infection, residual curvature, revision surgery, or pain. Early postoperative outcomes and complication rates following plaque incision or partial plaque excision and grafting with CFG were comparable in patients with mild/moderate and severe PD deformities. The technique may be a viable option with a similar risk profile for achieving penile straightening in selected PD cases, particularly when plication is not feasible.

First worldwide correction of ventral Peyronie's disease utilizing rigicon inflatable penile prosthesis combined with plaque incision & grafting with collagen fleece (PICS-technique) for residual curvature.

Adjunctive residual curvature correction by plaque incision and grafting with a sutureless graft during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) is our preferred technique. The PICS Technique (Penile Implant in Combination with the Sealing Technique) uses a self-adhesive collagen fleece (TachoSil®, Corza Medical, MA, USA) to cover the defect after plaque incision. The graft does not require sutures improving operative speed and avoiding needle stick of the implant cylinders. In this article, we present the first known application worldwide of a Rigicon Infla10® X (Rigicon, Ronkonkoma, NY, USA) device to Peyronie's ventral curvature. The patient's residual curvature of 80° after implantation was corrected by PICS through an additional subcoronal incision. At the conclusion of surgery, the penis was totally straight and rigid. No intra- and postoperative complications occurred. At the early follow-up of 12 weeks postoperatively, the patient was able to inflate and deflate the device and sexual intercourse was possible. A combination of the Rigicon Infla10® X and the PICS Technique represents a safe and successful approach for residual curvature correction during IPP in patients with ventral Peyronie's curvature. The Rigicon Infla10® X device showed excellent rigidity, and controlled expansion of the X cylinders means it can be used with the PICS Technique without restrictions. Early results are promising. Long-term follow-up and more patients are needed.

(036) The Comparison of an Efficacy and Safety of Geometrical Principles Based Corporoplasty Combined with Intraoperative Intracavernosal Prostaglandin E1 Injections and the Non-Geometrical Surgical Techniques for Peyronie's Curvature Correction

Abstract Introduction There is a lack of research evidence and properly conducted comparative long-term studies in regards to whether the intra and post-operative safety and efficacy of geometrical principle of plaque incision and grafting technique, especially if combined with an intraoperative intracavernosal prostaglandin E1 (PGE1) injection instead of saline, is better than the non-geometrical techniques. Objective The aim of this retrospective study was to present our 8-year single-center experience of surgical management of Peyronie's disease in the means of efficacy and safety by comparing geometrical principle of plaque incision and grafting technique combined with the intraoperative intracavernosal PGE1 injection with the other non-geometrical surgical techniques used at our centre for the treatment of penile curvature. Methods Our andrology centre approved this retrospective study and commenced an audit in order to obtain anonymised data. In total 70 patients underwent non-geometrical surgical techniques based penile curvature correction between 2014 and 2017. All the surgeries were carried out performing the intraoperative intracavernosal PGE1 injection instead of obtaining saline-induced erection. The demographic data was retrieved and a comparative analysis was performed. Results In total 216 (N=216) patients, aged 42–73 years old (average age 59 years) suffering from Peyronie's disease had surgical treatment of the curvature at our centre from 2014 to 2023. Group 1 (G1) patients accounted for 32.41% (N=70) of total patients - they were 46–78 years old (average age 64 years) and underwent non-geometrical principals based surgery for Peyronie's disease in between 2014 and 2017. Group 2 (G2) patients accounted for 68.52% (N=148) of total patients - they underwent the surgery using plaque's incision and grafting technique based on geometrical principles in between 2018 and 2023. 31 patients (44.3%) out of G1 required additional curvature corrections after an initial surgery, but only 3 patients (2.0%) out of G2 required that. Preoperative dorsal penile curvature degree among G1 was 50° - 100° (the mean degree 70°) and 60° - 110° (the mean degree 78°) among G2. 11 patients (15.7%) out of G1 and 15 patients (10.1%) out of G2 had the combined dorsolateral curvature. 3 patients (4.3%) out of G1 and 6 patients (4.1%) out of G2 had ventral curvature. 9 patients (12.9%) out G1 and 2 patients (1.4%) out of G2 have reported a subjective statement of their penile shaft appearing shorter after the curvature correcting surgery. 2 patients (2.9%) out G1 and 1 patient (0.7%) out of G2 have reported a subjective statement of erectile dysfunction post the surgery. There were no intraoperative or postoperative complications associated with the intracavernosal PGE1 injection. Conclusions In summary, we found that plaque's incision and grafting technique based on geometrical principles was advantageous against the other non-geometrical penile curvature surgical techniques due to better efficiency achieved by the higher initial success rates that require an additional correction almost twice less often. We also revealed that the intracavernosal PGE1 injection was a safe and sufficient method for inducing erection intraoperatively, that had not been associated with any complications and maintained the good outcomes of the surgical Peyornie's disease treatment. Disclosure No.

(097) 3 Year Follow Up After Modified Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie’s Disease

Abstract Introduction Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie’s plaque. Objective To assess the efficacy of technique in 32 patients with 3 year follow-up. Methods From 2018, 32 patients with stable Peyronie’s disease were included with 3 major steps of surgery; 1) dissection of neurovascular bundle/urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete correction of curvature/deformity, 3) sealing with TachoSil®. Prospectively, the stretched penile length (SPL), totally straightness, penile sono, erectile function at preoperative, and 6, 12, 24, 36 months postoperatively under approval of Institutional Review Board. Results Mean age was 59.2 years (46–72). Mean curvature was 53.5 (40–80) degree, 8 with hinge and 7 with hourglass deformity. IPP was inserted in 4 and 1 at postoperative 30 months for poor erectile function. Mean follow-up was 35.4 months (12–57). Daily massage softened the hard thickening of penis gradually from 3 months until 3 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1–3 year and tunical breakage by grid incision reunited at postoperative 10–12 months. 2 patients immediately recurred dorsal curvature but most patients achieved totally straightness. Most patients gained preoperative length after 1.6 year. 96% of patients satisfied in GAQ at 2 year. Minor skin problem was occurred in two of IPP. Subcutaneous bulging hematoma was occurred in 3 patients but subsided in two within 3 months. One patients need revision surgery. In postoperative erectile function of 23 patients without IPP, spontaneous hard erection was recovered in 5 and the rest are satisfied with PED5 inhibitors. Conclusions Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea but need long term follow up for 3 years at best. Disclosure No.

(168) Downgrading Surgical Recommendations After Intralesional Injections of Collagenase Clostridium Histolyticum in Peyronie’s Disease Patients

Abstract Introduction After patients undergo intralesional injections of collagenase clostridium histolyticum (CCH) as a primary treatment for Peyronie’s disease (PD), they may have residual curvature and may opt for secondary treatment with surgery. On the other hand, the initial severity of curvature may be best addressed by plaque incision and grafting (PIG), but the surgeon may offer CCH with the intent that post-CCH curvature can be treated with a penile plication (PP) rather than a PIG. Objective Our study investigated the group of PD patients who had their surgical recommendations downgraded from a plaque incision and grafting (PIG) to penile plication (PP), a less complicated procedure, after receiving CCH. Methods Our retrospective, single institution chart review included patients from 2016 to 2022 who underwent surgery to treat PD. We then looked at patients who underwent CCH then PP, and compared those who were initially recommended PIG before CCH to those who were initially recommended PP. Functional penile length was also evaluated as the length of the erect penis, from the base of the pubis to the tip of the glans, in a straight line while disregarding any curvature. Results Our study included 53 men who underwent surgery for treatment of PD, with mean age 56.0 (SD 11.3) at presentation. Of the 24 patients who underwent CCH, their pre-CCH and post-CCH surgery recommendations were: PP then PP in 5 patients (21%), PIG then PP in 11 (46%), PIG then PIG in 8 (33%) (Figure 1). The PIG then PP recommended group had a pre-CCH primary curvature range of 30 to 64 degrees, and post-CCH range of 16 to 46 degrees (Table 1). These patients had no significant difference in operative duration, difficulty, functional penile length, or complications (Table 2). The PIG then PP recommended group had 5 patients (46%) who reported functional residual curves that were manage conservatively, which was not significantly different from the PP then PP recommended group (0 patients, 0%, p=0.08). Conclusions Intralesional injections of CCH helped to downgrade surgical recommendations from the more drastic PIG to the simpler PP in a subset of PD patients, without compromising operative difficulty or postoperative outcomes. This finding is encouraging given that PP can be performed in a shorter operative time, by less experienced surgeons, and with lower risk of postoperative sensation and erectile issues. Disclosure No.

(187) The SAPOC Technique: Slices Around Point of Maximal Curvature at Time of IPP placement in Severe Peyronie's Disease

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease and erectile dysfunction (ED). Most cases involving plaque incision and graft placement are performed at the point of maximal curvature which result in a large defect that requires placement of a large graft while postoperative penile shortening remains a significant concern among patients. Objective To present a video of a novel modification of the multiple slit technique (MUST) for the treatment of severe PD and ED during IPP placement. This technique involves multiple relaxing incisions made around the point of maximal curvature (POMC) which minimizes the size or even the need of a graft while allowing for length restoration. Methods This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the POMC is identified, 2 to 4 transverse relaxing incisions (slices) are made around the POMC approximately 1 to 1.5cm apart in order to minimize the size of the defect and hence the need or size of the graft. Each slice allows for maximal restoration of length. Results The SAPOC technique results in correction of curvature and length restoration. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex PD and ED. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Boston Scientific and Coloplast.

Use of Soft Penile Prosthesis in Grafting Surgery for Peyronie's Disease and Mild Erectile Dysfunction: Still an Option?

Plaque incision and grafting (PEG) is a primary surgical therapy for severe penile curvature in Peyronie's disease (PD); However, it can increase the risk of erectile dysfunction (ED), particularly in patients with pre-operative mild ED. Soft penile prosthesis (SPP) implantation is a viable treatment option in such cases. This study aims to compare the outcomes of PEG-only approach to PEG plus SPP implantation. Between 2010 and 2019, 32 patients with PD and mild ED (5-item version of the International Index of Erectile Function scores: 17-21) underwent PEG surgery. Two groups were defined based on the surgery type: PEG-only and PEG plus SPP. The long-term outcomes included correction of penile bending, erection quality, intercourse ability, penile length and sensitivity. The overall satisfaction and impact of surgery on sexual activity and quality of life were also assessed. Of the 32 patients, 13 (40.6%) underwent PEG-only surgery, whereas 19 (59.4%) underwent PEG plus SPP. No significant differences were noted between the groups regarding pre-operative characteristics (all p > 0.1) or intra- and post-operative complication rates (all p > 0.2). The median patch area was larger in the PEG-only group (28 cm2 vs. 16.2 cm2; p = 0.001), whereas patients in the PEG plus SPP group were more likely to receive a single patch implant (100% vs. 53.8%; p < 0.001). The penile length increased in 18 patients (61.6%), with significant differences between the two groups (30% vs. 81.2%; p = 0.03). Overall, 14 patients (53.8%) reported greater satisfaction with their sexual life post-operatively, with comparable rates between the groups (p = 0.2). No significant differences were found in the post-operative 5-item version of the International Index of Erectile Function scores or severe post-operative ED (all p > 0.5). SPP placement during corporoplasty in patients with mild ED is safe and feasible, and it may be a suitable option for patients uncertain about inflatable prosthesis placement. The use of SPP resulted in longer penile lengths and necessitated smaller grafts. However, further data are required to understand the long-term clinical implications of this approach.

The comparison of success status and complications in peyronie disease patients: penile plication versus plaque incision and grating techniques

Aims: This study aimed to evaluate and compare the outcomes of tunical lengthening and shortening techniques for the surgical management of Peyronie's disease (PD) in terms of penile length, patient satisfaction, and complications.&#x0D; Methods: A retrospective analysis was conducted on PD patients who underwent surgical procedures between January 2017 and May 2023 at a single institute. Patient demographics, comorbidities, penile curvature, penile length, and surgical techniques were evaluated. The surgical procedures included plaque incision and grafting, and tunical plication. Post-operative data, including penile length, residual curvature, patient satisfaction, adverse events, and erectile function, were collected at 1-12 months of surgery. &#x0D; Results: A total of 36 patients (mean follow-up period: 432.25±121.14 days) underwent surgical procedures for PD. Penile length in the tunical lengthening group (13.04±1.62 cm) was significantly longer than in the tunical shortening group (10.85±1.24 cm, p=0.001). Tunical shortening procedures were associated with a higher rate of penile shortening (57.1% vs. 6.7%, p=0.001) and suture-related discomfort (38.1% vs. 6.7%, p=0.031) compared to tunical lengthening procedures. Patient satisfaction was higher in the tunical lengthening group (80% vs. 66.7%, p=0.378). There was no significant difference in painful erection during penetrations or incapability of intercourse between the groups. The average length of hospital stay was longer for tunical shortening surgery compared to tunical lengthening surgery (1.27±0.27 vs. 1.79±0.39, p=0.023).&#x0D; Conclusion: Tunical lengthening procedures demonstrated superior outcomes in terms of penile length and suture-related discomfort compared to tunical shortening procedures for the surgical management of PD. Patient satisfaction was also higher in the tunical lengthening group. Clinicians should consider various factors when selecting the appropriate surgical technique for PD, including penile length, the degree of penile curvature, and surgeon experience. Prospective randomized studies are needed to further validate these findings and assess long-term outcomes.

(405) Penile Prosthesis Implantation and Peyronie's Disease: How to Approach the Residual Curvature – A Detailed Demonstration of Moulding Technique and Grafting Procedure

Abstract Introduction Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing. Objective This video highlights strategies that will aid the implanter when faced with these intraoperative challenges. Methods This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (&amp;gt;30 degrees) following moulding. A fibrin sealant patch was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation. Results All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery. Conclusions Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including fibrin sealant patch or bovine pericardium. Disclosure No

(138) Smaller Tunical Defect With Pre-graft Plication Technique During Peyronie's Disease Surgery May Reduce Postoperative Erectile Function Loss

Abstract Introduction Peyronie’s disease (PD) is a progressive and benign acquired connective tissue disease characterized by disordered wound healing and local fibrosis of the tunica albuginea (TA). PD has two phases: acute and chronic. Surgery is the gold standard option for the correction of penile deformity in the PD chronic phase. Methods used in surgical treatment include plication, graft repair, and penile prosthesis implantation. Plaque incision (PIG) or excision (PEG) and graft placement are performed during graft repair. However, this technique can cause postoperative erectile dysfunction (ED) related to the size of the TA defect. Objective In our clinic, we use a novel "pre-graft plication technique" to reduce disruption of the integrity of the TA in patients with unidirectional curvature &amp;gt; 60 degrees. In this technique, we place 2 or 3 Essed–Schroder sutures on the convex side of the curvature before incision or excision and grafting on the plaque side. Thus, we pull the curvature angle down before PIG/PEG. We aim to improve post-op erectile function by using smaller grafts and TA incisions (figure 1). Our goal for this study was to compare the results of this technique with the standard PIG/PEG technique. Methods All patients who were operated on for PD in our clinic between 2010 and 2021 were screened. Patients aged between 40 and 70 years who underwent grafted PD repair were included in the study. Patients who underwent previous penile surgery or hormonal therapy, had significant preoperative ED (IIEF-5 &amp;lt; 17), or who received diagnoses of malignancy or depression were excluded from the study. We found 45 patients on whom we applied the pre-graft plication technique (group 1) and 32 patients on whom we applied the standard grafting technique who were appropriate for our inclusion and exclusion criteria. Demographic characteristics of the patients, comorbidities, preoperative IIEF-5 scores, stretched penile lengths, plaque sizes detected during surgery, graft sizes and types, postoperative IIEF-5 scores at the 3rd and 12th months, and 3-month postoperative penis lengths were recorded. Penile massage and daily 5 mg tadalafil were recommended as post-op rehabilitation. The results were compared with Student’s T-test. Results There were no significant differences between the groups in terms of preoperative IIEF-5 scores, penile lengths, age, or comorbidities. While there was no significant difference between the groups in the plaque sizes detected during the operation, the graft size used was significantly smaller in Group 1 than in Group 2. At follow-up, the IIEF-5 scores of the Group 1 were, on average, 1.97 and 2.36 points higher than Group 2 at 3 and 12 months of follow-up, respectively. This difference was statistically significant. There was no significant difference between the groups in terms of penile length (table-1). Conclusions Reducing post-op erectile function loss is possible with pre-graft plication technique. The extra plication suture does not cause a significant reduction in penile length. Disclosure No

(410) Multiple Slit Incisions with Tachosil® Grafting for Treatment of Peyronie’s Disease and ED

Abstract Introduction Plaque incision or partial excision with collagen fleece grafting and IPP implantation is a well-established treatment for severe penile curvatures associated with ED. Nevertheless, multiple plaque incisions combined with Tachosil® grafting may have added advantages. Objective We demonstrate step-by-step the treatment of a case of severe ED with an over 60 degree dorsal curvature mainly on the left side and an hour glass indentation on the right side of the penile shaft. We highlight the advantages of multiple plaque incisions and Tachosil® grafting combined with IPP implantation for these specific cases. Methods After IPP implantation via the penoscrotal approach, the neurovascular bundle was mobilized. For the left sided curvature we underwent multiple deep transverse slits starting from and around the point of maximum curvature using a low energy cutting current (20 to 30 Watts). Our transverse incisions were complimented with the modeling technique. For the right sided waist formation we underwent longitudinal slits. The area of incisions was covered by a Tachosil® graft. Results The multiple horizontal incisions led to a vertical release thus straightening of the curved penile shaft. Longitudinal slits led to a horizontal release, therefore expanding and obliterating of the waist formation. Conclusions The multiple slit technique together with Tachosil® grafting may have added advantages compared to the conventional plaque incision/excision utilizing the same graft. The smaller defects created by the multiple tunical incisions may avoid potential cylinder protrusion, facilitate better sealing of the collagen fleece, lower the incidence of hematoma and/or infections and allow complimentary modeling of the penis. Moreover, complex deformities may also be treated simultaneously with success. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

(139) Intraoperative Glanspexy During Complex Repair of Peyronie’s Disease

Abstract Introduction Peyronie’s disease (PD) is a disorder marked by the formation of a fibrous plaque in the tunica albuginea often causing a penile deformity. Surgical correction remains the gold standard of treatment for PD. The choice of procedure depends on various factors including erectile function, degree of penile curvature, hinge effect, and patient preference. We have found that men undergoing surgical correction of PD had intraoperative identification of a glans tilt or floppy glans, which was not recognized preoperatively. Objective Our aim was to analyze a large PD database to review the results after a glanspexy was performed in men undergoing partial plaque excision and grafting (PEG), tunica albuginea plication (TAP) or inflatable penile prosthesis (IPP) with straightening maneuvers. Methods A retrospective analysis was performed on all patients who presented with PD and were subsequently treated with a surgical procedure that included a glanspexy from 2016-2021. Demographics, comorbidities, erectile function (ED), PD characteristics, physical exam, penile duplex ultrasound findings, and surgical outcomes were obtained. Patients were tracked longitudinally, and subsequent interventions and outcomes were collected. All glanspexies were performed using the same surgical technique, where the glans was secured over the tips of the corpora cavernosa using several 4-0 Monocryl sutures between the glans and the tunica albuginea contralateral to the tilt through a subcoronal incision. Results A total of 97 glanspexies were performed in conjunction with an operation for PD. IPP with glanspexy (49.5%) was the most common procedure performed followed by PEG with glanspexy (36.1%) and TAP with glanspexy (14.4%). Post-operatively, there were no patient complaints or physician identification of irregularities pertaining to glans position or sensitivity. 6 patients required a reoperation after their initial PD procedure, however, none of the indications were related to the glanspexy portion of the procedure. There was one patient who sustained partial glans necrosis following complex reconstruction including extensive plaque incision with grafting, IPP and glanspexy. Conclusions Glanspexy using 4-0 Monocryl suture on a TF needle appears to be a safe, easy and effective technique for the treatment of a glans tilt or floppy glans identified during the surgical management of PD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

MP36-13 PEYRONIE'S DISEASE: PREPUTIAL GRAFT IN PENILE CURVATURE SURGERY CORRECTION, A SINGLE CENTER EXPERIENCE WITH 68 PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP36-13 PEYRONIE'S DISEASE: PREPUTIAL GRAFT IN PENILE CURVATURE SURGERY CORRECTION, A SINGLE CENTER EXPERIENCE WITH 68 PATIENTS Mattia Benedetti, Tommaso Arcelli, Nicola Nannola, Stefano Di Bari, Daniel Martens, Filippo Borgatti, Federcio Cantoni, Michele Potenzoni, Roberto Aarnaudi, Carmelo Destro Pastizzaro, Nicoletta Uliano, Chiara Grassani, Maria Chiara Sighinolfi, Stefani Ferretti, Stefano Puliatti, Bernardo Rocco, Andrea Prati, and Salvatore Micali Mattia BenedettiMattia Benedetti More articles by this author , Tommaso ArcelliTommaso Arcelli More articles by this author , Nicola NannolaNicola Nannola More articles by this author , Stefano Di BariStefano Di Bari More articles by this author , Daniel MartensDaniel Martens More articles by this author , Filippo BorgattiFilippo Borgatti More articles by this author , Federcio CantoniFedercio Cantoni More articles by this author , Michele PotenzoniMichele Potenzoni More articles by this author , Roberto AarnaudiRoberto Aarnaudi More articles by this author , Carmelo Destro PastizzaroCarmelo Destro Pastizzaro More articles by this author , Nicoletta UlianoNicoletta Uliano More articles by this author , Chiara GrassaniChiara Grassani More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Stefani FerrettiStefani Ferretti More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Andrea PratiAndrea Prati More articles by this author , and Salvatore MicaliSalvatore Micali More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical therapy for Peyronie's disease (PD) is reserved for patients with severe penile deformity that fails to improve with medical treatment and impedes sexual intercourse. Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. 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. Our purpose is to assess efficacy, complications and degree of patient satisfaction of preputial skin graft for treatment of penile curvatures by grafting corporoplasty. 68 patients (15-76 y) were treated between 2012 and 2021, with a degree of curvature between 30° and 80° at Fidenza Hospital. The patients analyzed had more than 17 valutaden with IEFF-5 score before the surgical procedure. METHODS: The surgery was performed by subcoronal incision, next degloving and preputial patch preparation. Next detachment of the nervous vascular bundle and incision of the double inverted T plate and application of the preputial patch. Compressive medication and catheterization. All patients were hospitalized for 4 days with removal of compressive medication on the third day and removal of the bladder catheter. Post-operative medication about 7 days after discharge with no evidence of major complications (about 10 patients had penile hematoma resolved with conservative therapy). About 6 months after surgery, patients were asked about the degree of satisfaction valueted IEFF-5 and the possible appearance of postoperative penile curvatures. RESULTS: Of the 68 patients operated 44 (64.7% of patients) had an IEFF-5 greater than 17 without a recurrence of curvature, 19 patients had an IEFF-5 less than 17 (27.9%) without a recurrence of curvature, 5 patients (7.4%) had an IEFF-5 greater than 17 but had a penile curvature recurrence of less than 30%. Only 10 patients post-operative complication. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity. Preputial graft has similar outcome compared to other Autologous grafts like Vein, Tunica vaginalis, Tunica albuginea, Buccal mucosa, Lingual mucosa, Fascia lata. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e484 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Benedetti More articles by this author Tommaso Arcelli More articles by this author Nicola Nannola More articles by this author Stefano Di Bari More articles by this author Daniel Martens More articles by this author Filippo Borgatti More articles by this author Federcio Cantoni More articles by this author Michele Potenzoni More articles by this author Roberto Aarnaudi More articles by this author Carmelo Destro Pastizzaro More articles by this author Nicoletta Uliano More articles by this author Chiara Grassani More articles by this author Maria Chiara Sighinolfi More articles by this author Stefani Ferretti More articles by this author Stefano Puliatti More articles by this author Bernardo Rocco More articles by this author Andrea Prati More articles by this author Salvatore Micali More articles by this author Expand All Advertisement PDF downloadLoading ...

V11-12 MULTIPLE SLIT INCISIONS WITH TACHOSIL® GRAFTING FOR TREATMENT OF PEYRONIE'S DISEASE AND ED

You have accessJournal of UrologyCME1 Apr 2023V11-12 MULTIPLE SLIT INCISIONS WITH TACHOSIL® GRAFTING FOR TREATMENT OF PEYRONIE'S DISEASE AND ED Ahmed Ragheb and Daniar Osmonov Ahmed RaghebAhmed Ragheb More articles by this author and Daniar OsmonovDaniar Osmonov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Plaque incision or partial excision with collagen fleece grafting and inflatable penile prosthesis (IPP) implantation is a well-established treatment for severe penile curvatures associated with ED. Nevertheless, multiple plaque incisions combined with Tachosil® grafting may have added advantages. We demonstrate step-by-step the treatment of a case of severe ED with an over 60 degree dorsal curvature mainly on the left side and an hour glass indentation on the right side of the penile shaft. We highlight the advantages of multiple plaque incisions and Tachosil® grafting combined with IPP implantation for these specific cases. METHODS: After IPP implantation via the penoscrotal approach, the neurovascular bundle was mobilized. For the left sided curvature we underwent multiple deep transverse slits starting from and around the point of maximum curvature using a low energy cutting current (20 to 30 Watts). Our transverse incisions were complimented with the modeling technique. For the right sided waist formation we underwent longitudinal slits. The area of incisions was covered by a Tachosil® graft. RESULTS: The multiple horizontal incisions led to a vertical release thus straightening of the curved penile shaft. Longitudinal slits led to a horizontal release, therefore expanding and obliterating the waist formation. CONCLUSIONS: The multiple slit technique together with Tachosil® grafting may have added advantages compared to the conventional plaque incision/excision utilizing the same graft. The smaller defects created by the multiple tunical incisions may avoid potential cylinder protrusion, facilitate better sealing of the collagen fleece, lower the incidence of hematoma and/or infections and allow complimentary modeling of the penis. Moreover, complex deformities may also be treated simultaneously with success. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1002 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ragheb More articles by this author Daniar Osmonov More articles by this author Expand All Advertisement PDF downloadLoading ...

Bionic artificial penile Tunica albuginea

Bionic artificial penile Tunica albuginea

AUTHOR REPLY

We would like to express our gratitude for your comments on our article “Comparison of technical success and adverse events of plaque incision and grafting methods in patients with Peyronie's disease: Tunica vaginalis versus buccal mucosa.” It is a great honor for us that our article has aroused such interest.

Comparison of Technical Success and Adverse Events of Plaque Incision and Grafting Methods in Patients with Peyronie's disease: Tunica Vaginalis versus Buccal Mucosa

ObjectiveTo compare the clinical outcomes of Peyronie's disease (PD) patients who were treated by plaque incision and grafting either with tunica vaginalis (TV) or buccal mucosa (BM) grafts. MethodsPD patients in BM (n=20) and TV group (n = 20) were recruited between 2013 and 2020. Erectile dysfunction was assessed by short form of International Index of Erectile Function Questionnaire (IIEF-5). Technical success was defined as residual curvature ≤15°. Penile Doppler ultrasound was performed at baseline evaluation, 3-, and 24 months. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in erect penis. Erect penile length and curvature angle were measured at baseline and at 3, 12, and 24 months. ResultsMean age of the groups was comparable (47.2 ± 10.8 years in TV vs 46.5 ± 9.9 years in BM groups). Baseline mean penile curvature was 48.0 ± 6.6° (TV) and 50.3±11.6° (BM) (P <.001). Mean residual curvature at 24-month visits was 12.4 ± 4.9° (TV) and 7.9 ± 3.7° (BM), not significantly different. Technical success rate was 90% for both groups at 24 months. Surgery significantly increased erect penile length in both groups. Mean preoperative IIEF-5 scores were 18.4 ± 2.5 and 17.5 ± 2.2 in TV and BM groups, respectively. In both groups, IIEF-5 scores significantly improved after surgery with no intergroup IIEF-5 difference (20.6 ± 2.6 in TV and 21.3 ± 2.2 in BM). Mean postoperative PSV significantly increased, EDV significantly decreased in both groups, however, there was no significant intergroup difference. ConclusionBoth grafting materials provided similar beneficial effects regarding technical success, erectile dysfunction, and penile length.

Medium-long-term outcomes of saphenous vein graft in Peyronie surgery: Is there a need for new graft material?

AimWe present our results of tunical incision and saphenous graft surgery for men with short penis and who cannot have sexual relations due to curvature linked to chronic Peyronie plaques. IntroductionPeyronie disease is a chronic process where fibrotic plaques form in the tunica albuginea. The plaques cause pain in the acute period and cause the penis to bend after inflammation ends. Surgical procedures are required for curvature>30°. Saphenous vein graft (SVG) replacement is an alternative method for tunical plaque incision defect. Material-methodThe outcomes for 71 patients with TI+SVG surgery were retrospectively assessed. Plaque features (curvature angle, location, direction of curve and tunical defect diameter), operative and postoperative properties (surgery duration, recurrent curvature, penis shortening, glans hypoesthesia, satisfaction score, follow-up duration), preoperative–postoperative penis length and IIEF-5 score differences were assessed. ResultsMean age was 61.12±7.9 (45–75) years, mean curvature angle was 62.0±14.7 (50–90), location was mid-penile for 46 (65%), with angulation direction toward the dorsal for 37 (52%), and the defect area after tunical incision was 15.5±3.9 (10–23) cm2. With mean follow-up duration of 37±9.4 months, 9 patients had re-curvature (13.2%), 8 had short penis (11.3%) and 7 had ED identified (9.4%). Total penis straightening was present for 86.8%, with patient satisfaction score of 21.1±4.4 (8–25). ConclusionThe TI+SVG method is an effective method for Peyronie surgery in the medium-long term.

Autologous testicular tunica vaginalis graft in Peyronie's disease: a prospective evaluation.

Peyronie's disease (PD) is a two-phase progressive condition characterized by inelastic plaques in the tunica albuginea of the penis, leading to curvature of the penis. Men with PD also suffer from psychological distress, and sexual life and overall quality of life. Although the preferred surgical treatment modality in Peyronie's disease is plaque incision and grafting, there is lack of studies assessing the erectile function and penile vasculature after the treatment. We aimed to evaluate the efficiency and safety of plaque incision and tunica vaginalis of testis grafting in PD. This was a prospective analysis. Erectile dysfunction was assessed via International Index of Erectile Function Questionnaire (IIEF-5). Penile Doppler ultrasound was performed to assess peak systolic velocity (PSV) and end-diastolic velocity (EDV). Postoperative follow-ups were scheduled at 3, 12, and 24months. Twenty patients (mean age 47.2 ± 10.8years) were included. The mean preoperative penile curvature was 48 ± 6.6°. The technical success rate was 100% at 3months and 90% at 24months. At follow-up visits, mean erect penile length was no different from the baseline. The baseline mean IIEF-5 score was 18.4 ± 2.5. The mean IIEF-5 score was 20.6 ± 2.6 at 24-month visit (p < 0.0001). Mean PSV significantly increased, while EDV significantly reduced after surgery. There were no serious complications related to surgery. We conclude that surgical reconstruction of penile curvature with tunica vaginalis grafting was a safe and effective procedure in PD.

PD23-08 POSTOPERATIVE PROGRESS OF MODIFIED GRID INCISION AND SEALING WITH COLLAGEN FLEECE FOR TREATMENT OF PEYRONIE’S DISEASE; CLINICAL AND ULTRASONOGRAPHY OUTCOME

You have accessJournal of UrologyCME1 May 2022PD23-08 POSTOPERATIVE PROGRESS OF MODIFIED GRID INCISION AND SEALING WITH COLLAGEN FLEECE FOR TREATMENT OF PEYRONIE’S DISEASE; CLINICAL AND ULTRASONOGRAPHY OUTCOME Sun Tae Ahn, Sun Bum Cho, Hyun Soo Lee, Da Eun Han, Jong Wook Kim, and Mi Mi Oh Sun Tae AhnSun Tae Ahn More articles by this author , Sun Bum ChoSun Bum Cho More articles by this author , Hyun Soo LeeHyun Soo Lee More articles by this author , Da Eun HanDa Eun Han More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , and Mi Mi OhMi Mi Oh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, there have been reports on partial plaque excision and grafting with collagen fleece technique regarding long term efficacy. However, there is still concern regarding complete regeneration of tunical defect from collagen fleece in terms of regenerative medicine. Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie’s plaque to minimize weakness of regenerated tunica from the collagen fleece graft. Therefore, this study aimed to evaluate the effects of our modified technique through a prospective follow-up study including ultrasonography. METHODS: From Aug 2018, 31 patients with stable Peyronie’s disease were included. Surgical technique was composed 3 major steps; 1) dissection of the neurovascular bundle or urethra according to the location of plaque, 2) multiple deep grid plaque incisions for complete correction of curvature and deformity and 3) sealing with collagen fleece without suturing. Prospectively, we assessed the stretched penile length, totally straightness, penile sono, erectile function preoperatively and 6, 12, 24, 36 months postoperatively. RESULTS: Mean patient age was 58.5 years (range: 46–75). The mean curvature was 45.95 (15-90) degrees, 8 with hinge and 7with hourglass deformity. Inflatable penile prosthesis(IPP) was inserted in 4 patients and postoperative 30 months in a patient for poor erectile function. Mean follow-up was 15 months (6-36). Daily massage softened the hard thickening of penis gradually from 3 months until 2 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1 year and the breakage of tunica by grid incision reunited at postoperative 10-12 months (Figure 1.). All patients achieved totally straightness. Minor skin problem was occurred in 3 patients of IPP. Subcutaneous bulging hematoma was occurred in 2 patients but subsided within 3 months. In postoperative erectile function of 27 patients without IPP, spontaneous hard erection was recovered in 10 and the rest are satisfied with PED5 inhibitors. CONCLUSIONS: Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e412 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sun Tae Ahn More articles by this author Sun Bum Cho More articles by this author Hyun Soo Lee More articles by this author Da Eun Han More articles by this author Jong Wook Kim More articles by this author Mi Mi Oh More articles by this author Expand All Advertisement PDF DownloadLoading ...