A Geometric Model of Plaque Incision and Graft for Peyronie's Disease with Geometric Analyses of Different Techniques

Miranda, Alexandre Franco; Sampaio, Francisco J.B.

doi:10.1111/jsm.12462

Cited by 16 publications

(10 citation statements)

References 17 publications

(19 reference statements)

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“…Using our previously described knitted cotton fabric cylinder model, 2 we studied different ways to correct penile curvature without causing mechanical or geometrical distortions and learned the following:To fold a cylinder without causing deformities, at least three-fourths of the cylinder's circumference should be opened 2

The easier way to correct a curvature is performing a linear transversal incision and inserting a graft; nevertheless, this reduces the cylinder's diameter on the incision site.

…”

Section: Methodsmentioning

confidence: 99%

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

Miranda

Sampaio

2016

Sexual Medicine

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IntroductionPenile curvature correction with plaque incision and graft (PIG) increases the risk of erectile dysfunction (ED) and is associated with mechanical and geometric abnormalities.AimsThe aim of this study was to create and validate a new PIG technique using minimum graft area to correct simple or complex penile curvature with or without hourglass deformity, while avoiding mechanical and geometric abnormalities.MethodsUsing our cotton fabric model, we created a mathematic solution for PIG with no residual defects. This was applied in nine men who had sufficient penile rigidity while penetrating their respective partners. They underwent fascia lata patch corporoplasty using the new developed technique (iPad [Apple Corp, Palo Alto, CA, USA] app: iGrafter). Subjects answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire preoperatively and at the end of follow-up.Main Outcome MeasuresThe main outcome measures used were patient demographics, erectile function, residual curvature, patient satisfaction, graft area, and complications.ResultsAfter a mean follow-up of 17.8 months, no significant complication was noted. Complete penile straightening was achieved in all patients. The short side of the penis increased a mean of 3 cm in length, and the mean graft area was 12.4 cm2. At the end of the follow-up, three patients developed recurrent deformity. One patient presented severe fibrosis in the corpora cavernosa and severe ED. There was no significant difference between the mean preoperative and postoperative IIEF-5 scores (20.6 vs 19.4, respectively). At the end of follow-up, all patients were able to have sexual intercourse (two with and seven without pharmacological aid). Eight of the nine patients were satisfied with the surgical result.ConclusionPenile curvature surgical correction using the iGrafter seems to be an efficient and safe procedure, which uses minimum graft area and preserves erectile function after penile rectification, without resulting in residual deformities. Further research is needed to confirm the efficacy of this procedure.

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The easier way to correct a curvature is performing a linear transversal incision and inserting a graft; nevertheless, this reduces the cylinder's diameter on the incision site.

…”

Section: Methodsmentioning

confidence: 99%

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

Miranda

Sampaio

2016

Sexual Medicine

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“…On occasion, multiple incisions and, sometimes, additional tunical plication, may be needed to attain satisfactory straightening (Levine & Burnett, ). More recently, newer techniques have been described using geometrical principles aimed at obtaining more accurate graft sizes (Egydio et al ., ; Miranda & Sampaio, ). Furthermore, when the plaque is very dense and causes severe indentation, it is sometimes advisable to proceed with a partial excision of the plaque to allow for better correction of the narrowing (Sherer et al ., ).…”

Section: Surgical Therapymentioning

confidence: 99%

Therapeutic advances in the treatment of Peyronie's disease

2015

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SUMMARYPeyronie's disease (PD) is an under-diagnosed condition with prevalence in the male population as high as 9%. It is a localized connective tissue disorder of the penis characterized by scarring of the tunica albuginea. Its pathophysiology, however, remains incompletely elucidated. For the management of the acute phase of PD, there are currently numerous available oral drugs, but the scientific evidence for their use is weak. In terms of intralesional injections, collagenase clostridium histolyticum is currently the only Food and Drug Administration-approved drug for the management of patients with PD and a palpable plaque with dorsal or dorsolateral curvature >30°. Other available intralesional injectable drugs include verapamil and interferon-alpha-2B, however, their use is considered off-label. Iontophoresis, shockwave therapy, and radiation therapy have also been described with unconvincing results, and as such, their use is currently not recommended. Traction therapy, as part of a multimodal approach, is an underused additional tool for the prevention of PD-associated loss of penile length, but its efficacy is dependent on patient compliance. Surgical therapy remains the gold standard for patients in the chronic phase of the disease. In patients with adequate erectile function, tunical plication and/or incision/partial excision and grafting can be offered, depending on degree of curvature and/or presence of destabilizing deformity. In patients with erectile dysfunction non-responsive to oral therapy, insertion of an inflatable penile prosthesis with or without straightening procedures should be offered.

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“…There are three broad categories of TA plaque incision (double-Y, H-shaped, and Egydio geometric) that are made at the point/relative to the maximum curvature on the convex side of the penis, followed by placement of a graft material(autologous, allografts, xenografts, and synthetic) to repair the defect and potentially lengthen the shorter side of the penis. 1,3,[69][70][71][72]76,78,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101] There is a strong trend towards minimal TA disruption, therefore favoring incision or partial excision techniques;…”

Section: Grafting Proceduresmentioning

confidence: 99%

2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

Bella

Lee

Grober

et al. 2018

CUAJ

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Peyronie’s disease (PD) is a highly prevalent condition that affects the physical and psychosocial well-being and quality of life (QoL) for thousands of Canadian men. The specific etiology of PD remains poorly understood and there remains a paucity of randomized placebo-controlled trials evaluating treatment interventions.1-3 PD can be found in up to 8.9% of men, a remarkable increase in cited prevalence that is attributable to growing awareness (as historical data suggested a rate of less than 1%); the burden of disease is significant, and PD is often present in otherwise healthy men. The following guidelines were crafted by the committee with a full awareness of the limitations of the literature, and sought to provide actionable recommendations to guide PD care in the Canadian health system.

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A Geometric Model of Plaque Incision and Graft for Peyronie's Disease with Geometric Analyses of Different Techniques

Cited by 16 publications

References 17 publications

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

Therapeutic advances in the treatment of Peyronie's disease

2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

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