Long-term follow-up on use of pericardial graft in the surgical management of Peyronie's disease

Abstract

We have previously reported on the use of Tutoplast 1 cadaveric pericardium as an alternative material for grafting the tunica albugineal defect after Peyronie's plaque excision with satisfactory results in 11 patients. We now review long-term outcomes in this cohort of men. Eleven patients with signi®cant penile curvature interfering with sexual intercourse were evaluated after at least 12 months of conservative therapy. All patients underwent pre-operative evaluation, including penile duplex Doppler ultrasound studies. Chemically processed and gamma-irradiated pericardium (Biodynamics International, Parsippany, NJ) was used to graft the cavernosal defect after surgical excision of the penile plaque. Three patients simultaneously underwent placement of penile prostheses secondary to documented erection problems identi®ed at duplex Doppler ultrasound evaluation. The long-term postoperative complications and erectile function were evaluated with a mean follow-up of 30 months (range 25 ± 35 months). All patients reported resolution of penile curvature allowing for normal sexual function after a mean follow-up of the ®rst 14 months. Thirty months after placement of cadaveric pericardium, the three prosthetic patients still reported excellent sexual function. For the eight patients who did not undergo placement of a prosthesis, three with small to medium plaque size (`265 cm) continued to do well. The remaining ®ve patients with a large plaque size (b265 cm) did well initially, but later reported dif®culty maintaining erection due to venous leakage, thus they are currently using either a vacuum constriction device or an Actis ring. Three out of these ®ve venous leakage patients had ventral plaques; two had dorsal plaques, one of signi®cant size (465 cm). We conclude that for those patients who do not undergo placement of a prosthesis, a better long-term outcome is observed when the plaque is small to medium in size (`265 cm) and dorsally located. Patients with ventral plaque, extreme curvature, or plaque size b465 cm were more likely to have venoocclusive dysfunction, necessitating further intervention.

Surgical treatment of Peyronie's disease based on penile length and degree of curvature

“…However, significant 30 and 63% of erectile dysfunction have been observed when this graft is used after incision and plaque excision, respectively. 22,25 Disadvantages of synthetic materials are graft contraction due to the lack of elasticity and risk of allergic reaction and infection. 6 In this study, we used polytetrafluoroethylene patches because of the easyavailability and especially because of tensile strength, which we consider the advantage of this material, particularly in the correction of larger defects of the tunica albuginea.…”

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

“…The outcomes of 15 patients undergoing penile reconstruction using HCP revealed an approximately 52% success rate in 2 studies [9,41]. Other human studies using HCP compared the result of the pericardial graft with other substitutes (i.e., dermal grafts, penile remodeling, or tunica albuginea plication).…”

“…The main disadvantages, however, are its relatively high costs and possible poor availability [9,66]. Tutoplast ® is a patented form of the HCP graft.…”

“…A variety of grafts including skin, bladder, colon, and buccal mucosa have been utilized in reconstructive urologic surgeries [4][5][6]. More recently, some other tissues such as amniotic membranes [7] and pericardial tissues have been used in reconstructive urologic surgeries [8][9][10][11].…”

Peyronie’s Disease: Lights and Shadows

“…It consists of human pericardium which undergoes a process of preservation and sterilization by viral and immunological deactivation. All tissues come from cadaveric donors that fit all legal and ethical standards [63] . Tutopatch seems to be a reliable graft due to its preserved elasticity at longterm follow-up.…”