Multicenter Experience Using Collagen Fleece for Plaque Incision with Grafting to Correct Residual Curvature at the Time of Inflatable Penile Prosthesis Placement in Patients with Peyronie's Disease

Abstract

Background Adjuvant maneuvers are often necessary to correct residual curvature during inflatable penile prosthesis (IPP) placement in patients with Peyronie's disease (PD). Aim We present our multicenter experience using collagen fleece as graft material for plaque incision and grafting (PIG) during IPP placement in patients with moderate to severe PD. Methods We retrospectively reviewed 51 patients with IPP from 3 sites who underwent PIG with Tachosil (Baxter, IL) collagen fleece. Coloplast (Minneapolis, MN) IPP devices were used. Factors associated with residual curvature, revision, and patient satisfaction were performed using chi-squared analysis. Outcomes We evaluated postoperative outcomes including factors associated with residual curvature, revision, and patient satisfaction. Results The mean compound curvature was 69.6°. The mean follow-up was 10.6 (range 1–38) months. All patients reported erections sufficient for penetrative intercourse at the last follow-up. Residual curvature <15° was noted in 6 of 51 (12%) patients. 3 patients required device revision. 2 patients experienced temporary glanular paresthesia, and no patients experienced device infection. Clinical Implications In our multicenter study, patients experienced substantial curve correction with minimal complications, and in the few patients who had persistent mild curvature, severe preoperative curvature (>60°) was found to be the only risk factor. Strengths & Limitations Our study represents the largest series of patients coming from multiple centers undergoing surgical correction of PD with IPP and collagen fleece grafting. Limitations of this study include the retrospective study design, lack of a comparison group, and modest follow-up. Conclusion PIG using collagen fleece is a safe and effective means of correcting residual curvature after IPP placement in patients with moderate to severe PD.

Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie’s disease in a multicenter clinical study

“…Thereafter, the size of the albugineal defect was carefully measured and the graft shaped accordingly. In this context, either bovine pericardium graft [Collagen Matrix, Baxter Healthcare Corporation, CA, USA] or collagen fleece (Baxter Healthcare Corporation, CA, USA) have been used as grafting materials, based on surgeon's preference, according to previous report 11 . More in depth, when bovine pericardium graft was applied, the patch was oversized by 30% to prevent subsequent excessive contractures and fixed to the edges of the tunical defect with a 4-0 PDS running suture (Fig.…”

A comprehensive narrative review of residual curvature correction during penile prosthesis implantation in patients with severe erectile dysfunction and concomitant Peyronie’s disease

“…Only 11 articles were published until 2010 (14,16,(24)(25)(26)(27)(31)(32)(33)(34)(35). Most of the articles were published during the last decade (17)(18)(19)(20)(21)(22)(23)(28)(29)(30)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Most studies had a retrospective design and only five studies were prospective (21,24,27,41,43).…”

“…Nineteen studies investigated the results of PPI with additional tunical/plaque incision/excision and grafting of the defect for the correction of severe residual penile curvature (Table 4) (14,20,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). They included a total of 1,072 patients with a pooled mean age of 59.8 years (ranged from 51.2 to 67.2) and a pooled mean follow-up of 27 months (ranged from 6.6 to 45 months) (14,20,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Most studies assessed the use of inflatable 3-piece penile prosthesis (14,20,31,38,(42)(43)(44)(45)47)...…”

“…They included a total of 1,072 patients with a pooled mean age of 59.8 years (ranged from 51.2 to 67.2) and a pooled mean follow-up of 27 months (ranged from 6.6 to 45 months) (14,20,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Most studies assessed the use of inflatable 3-piece penile prosthesis (14,20,31,38,(42)(43)(44)(45)47), while many of them included patients with both inflatable and malleable penile prosthesis (33,34,36,37,39,41,46). Two studies evaluated the use of only malleable penile prosthesis (32,40).…”

“…Other grafting materials included porcine small intestinal submucosa (37,41,43), InteXen collagen dermal matrix (36,38), PTFE-GoreTex ( 14), saphenous vein (32), and autologous rectus sheath (35). Of note, all the new and recently published studies assessed the use of collagen fleece to cover the defect (43)(44)(45)(46)(47). Additionally, one trial compared the effect of pericardium versus collagen fleece (45) and another porcine small intestinal submucosa versus collagen fleece (43).…”