Penile Dermal Flap in Patients With Peyronie's Disease: Long-Term Results

Simonato, Alchiede; Gregori, Andrea; Varca, Virginia; Venzano, Fabio; Rose, Aldo Franco De; Ambruosi, Carlo; Esposito, Marco; Carmignani, G.

doi:10.1016/j.juro.2009.11.020

Cited by 20 publications

(26 citation statements)

References 15 publications

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“…[46][47][48] The reported patient satisfaction Larsen 29 rate with these procedures ranges from 41% to 96%, partner satisfaction has been reported at 77% and rigidity adequate for coitus reported from 79% to 100%. 22,46,[48][49][50][51] ED is reported in 0%-35% with a trend toward increased risk of ED in men over the age of 60 years, as well as a higher risk of ED when grafting is performed to correct ventral curvature. 22,48 Depending on the graft material used, recurrence of greater than 30u curvature can be seen from 0% to 16% with plaque incision/excision and grafting procedures.…”

Section: Tunical Lengthening Procedures (Incision or Partial Excisionmentioning

confidence: 99%

Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

110

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Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 706 without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems. Keywords: penile prosthesis; Peyronie's disease, penile reconstruction; plaque excision and grafting; plaque incision; tunica albuginea plication INTRODUCTION Peyronie's disease (PD) is most simply referred to as a fibrotic woundhealing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing, shortening and painful erections. 1 The perceived loss of length and girth is often more disturbing than the curvature itself, all of which can lead to moderate to severe depressive symptoms, emotional, and relationship problems. 2,3 Despite a myriad of treatment options, PD remains a considerable therapeutic dilemma due to several factors including an incomplete understanding of its etiopathophysiology and the relative paucity of randomized, placebo-controlled trials. A general explanation of this disorder, which has gained acceptance, is that PD is a disorder in which genetically susceptible individuals experience a localized response to endogenous factors such as tumor growth factor-b, which are released in response to microtrauma. This can lead to biological transformation of cells within the tunica albuginea, cell cycle dysregulation, genotypic changes and increased expression of cytokines and free radicals. This inflammatory response leads to unregulated extracellular matrix deposition including fibronectin and collagen, and ultimately plaque scar formation, which does not appear to undergo proper scar remodeling, leaving an inelastic segment in the involved tunica albuginea. [4][5][6][7][8][9] Although a variety of non-surgical treatments have been suggested, none offer a r...

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Section: Tunical Lengthening Procedures (Incision or Partial Excisionmentioning

confidence: 99%

Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

110

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“…These results are similar with those of other studies in which patients reported also low satisfaction rates after a long-term follow-up. 21,23,27 The relatively low satisfaction rates in the present study and other questionnaire-based studies also need to be judged under the perspective that such questionnaire-based studies tend to lead to significantly less positive results than direct interviews as reported by van der Horst et al…”

Section: Discussionmentioning

confidence: 57%

“…Even though some studies described excellent results after grafting procedures, 26,35 others reported, in accordance with our observations, a reduced erectile function of patients after a grafting procedure. 21,23,27 Hsu et al 26 reported equivalent erectile function after venous grafting procedures in comparison to the preoperative situation in patients with PD and with congenital deviation after an average follow-up of 43 months (7 month to 10 years), whereas Kim et al 27 described a significantly reduced erectile function/rigidity after a grafting procedure with venous patches after a medium follow-up time of at least 1 year compared to simpler shortening procedures. Also in line with the results of our study, Kim et al 27 described a higher loss of sensation in patients after grafting procedure than after ST procedures even though differences in our study were statistically not significant.…”

Section: Discussionmentioning

confidence: 99%

“…According to these techniques the plaque (located on the shorter (concave) part of the deviation) is either incised or completely removed. The consecutive defect of the corpora cavernosa is then covered by a graft which can consist of different materials: 18 autologous materials like vena saphena magna, 19,20 allogenic pericardial 21 or dermis grafts, 22,23 but also xenogenous materials like small intestinal submucosa 24 or collagen matrices 25 are applied. Even though some publications already report successful surgical treatment, long-term follow-up data especially with regard to the functional outcome remain scarce.…”

Section: Introductionmentioning

confidence: 99%

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A self-reported long-term follow-up of patients operated with either shortening techniques or a TachoSil grafting procedure

Horstmann¹,

Kwol²,

Amend³

et al. 2011

Asian J Androl

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The aim of this article is to analyse the long-term results of different surgical techniques for correction of penile deviations in Peyronie's disease. Patients who underwent surgery for a penile deviation in Peyronie's disease between 1997 and 2007 were included into this study. Cases were retrospectively analysed by chart review. The current situation was evaluated by a 16-item standardized questionnaire addressing penile straightness, sensation, length, sexual function and satisfaction. Ninety patients were contacted with a return rate of 75 (83%) evaluable questionnaires. Thirty-two patients were operated by shortening techniques (STs) with either Schroeder-Essed (n516) or Nesbit (n516). Forty-three were operated by a plaque in-/excision and defect covering by TachoSil method (TM). Both groups were similar regarding age (ST 56 years, TM 57 years), comorbidities, mean preoperative erection hardness score (EHS; 3.1 ST, 3.4 TM) and time of follow-up (total mean, 63 months). Preoperatively ST patients had significantly less plaques (P,0.05) and a lower deviation angle in comparison to TM patients (ST 566 versus TM 746; P, 0.001). Still TM patients reported slightly better straightening results, but a significantly lower mean EHS (ST 3.3 versus TM 2.6; P,0.001) during the follow-up. Satisfaction rates were similar in both groups. In conclusion, both techniques revealed to be safe and sustainable successful in penile straightening with better functional outcome of patients operated by STs.

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“…Complex surgical procedures using grafts are often used in penile reconstructive surgery, presenting a wide range of success rates. This suggests that the ideal graft for hTA substitution is not yet available [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Human Acellular Matrix Graft of Tunica Albuginea for Penile Reconstruction

Silva

Filho

Damião

et al. 2011

The Journal of Sexual Medicine

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Introduction Penile curvature is one of the most common male conditions, affecting nearly 10% of men, and can impair sexual intercourse. Tunica albuginea (hTA) plays a key role in penile curvature, and reconstructive procedures may be necessary for its substitution. Although several grafts have been proposed for hTA repair, the ideal graft is not yet available. Aim The aim of this article is to evaluate a new human tunica albuginea acellular matrix (hTAAM) as potential graft for penile reconstructive procedures. Methods Twelve penises were obtained during sex reassignment surgeries from male-to-female transsexual patients. After dissection, hTAs were assigned into two groups according to the decellularization methods: polyethylene glycol (PEG) 1000 method following ultraviolet-C radiation, and Triton X-100 modified method. Main Outcome Measures Structural analyses were assessed by hematoxilin and eosin, Masson's trichrome, Weigert's, and picrosirius-polarization staining methods. Total protein, total glycosaminoglycan (GAG), and nucleic acid (DNA and RNA) concentrations were assessed by specific biochemical analyses. Uniaxial strength tests were performed to evaluate biomechanical properties. Results All hTAAMs presented no nuclear or cellular remnants. Total protein concentration was significantly higher in PEG 1000 hTAAM. Despite GAG concentration decreased significantly in hTAAM, Triton X-100 hTAAM retained the highest GAG concentration (1.0 ± 0.42 µg HexUr/mg dry tissue, P > 0.05). All decellularization methods were efficacious to remove nucleic acids. The maximal break point presented no difference between hTA and hTAAM groups (P > 0.05). Conclusions PEG 1000 and Triton X-100 decellularization methods provide equally successful hTAAMs, preserving original structural and biochemical properties.

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Penile Dermal Flap in Patients With Peyronie's Disease: Long-Term Results

Cited by 20 publications

References 15 publications

Surgery for Peyronie's disease

Surgery for Peyronie's disease

A self-reported long-term follow-up of patients operated with either shortening techniques or a TachoSil grafting procedure

Human Acellular Matrix Graft of Tunica Albuginea for Penile Reconstruction

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