Plaque incision and grafting represents the best surgical approach to the Peyronie’s disease patient: Con

Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios

doi:10.1007/s11930-996-0003-9

Cited by 1 publication

(2 citation statements)

References 68 publications

(72 reference statements)

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“…In spite of this, results are not devoid of complications, the most serious is the development of de-novo ED, which seems to be caused by complete surgical excision of the plaque (12). Nowadays, plaque incision surgery with grafting is the preferred therapeutic approach (3,8).…”

Section: Discussionmentioning

confidence: 99%

“…The diagnoses are increasing in number, even in the younger population, because of the increased knowledge about the topic (2). Surgical treatment remains the gold standard and it includes penis plication, grafting, and placement of inflatable prosthesis with the aim to restore coital functions (3). Buccal mucosa grafts (BMG) provided excellent shortterm results, suggested by the early recovery of spontaneous erections and the prevention of late shrinkage, which is the main cause of graft failure.…”

Section: Introductionmentioning

confidence: 99%

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Buccal mucosa graft in surgical management of Peyronie’s disease: Ultrasound features and clinical outcomes

Fabiani¹,

Fioretti²,

Pavia

et al. 2021

Arch Ital Urol Androl

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Introduction: Plaque incision and grafting represent the best surgical approach to the Peyronie’s Disease (PD). The grafting procedures must be restricted to patients with normal preoperative status, excessive curvature and/or deformities. However, the ideal graft has not been identified yet. Buccal mucosa grafts (BMG) provided excellent short-term results, ensuring the fast return of spontaneous erections and preventing shrinkage, which is the main cause of graft failure. Another fearsome surgical complication is de novo erectile dysfunction (ED). We report our results with BMG focusing on the analysis of ultrasonographic and clinical data demonstrating buccal mucosa as determinant factor that allow to avoid complications. Materials and methods: From 2013 to 2019 we performed at our Urology Unit 27 corporoplasties with BMG to correct complex penile curvature due to PD. Clinical, post-surgical and ultrasound follow up data were evaluated. All patients were no responders to medical treatment or previous surgical procedures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history and penile dynamic ultrasound (PGE1-induced erection) were collected. The time of spontaneous erection resumption was recorded for each patient. To improve blood supply to the graft, a low-dose PDE5-i was prescribed for all patients for a period of two months, starting immediately after discharge. Check-ups were scheduled every 3 months, starting from 1 month after surgery. In each visit, patients underwent a penile ultrasound evaluation of graft features. After 6 and 12 months, all patients underwent a penile dynamic ultrasound for Erection Hardness Score determination, then standard ultrasound and clinical evaluation yearly. Our analyses were focused on BMG as a major determinant of the surgical success. Results: Mean age of 27 patients was 57 years (42-71) with a maximum follow up time of 72 months and minimum of 3. Site of penile curvature was dorsal in 18 (67%) patients, ventral in 2 (7%), complex in 7 (26%). The degree of the curvature was < 60° in 11 (41%) patients, > 60° in 16 (59%). Straightening of penis was reached in 100% of cases. Penile shortening resulted in 7.4% (2/27). De novo ED appeared in 2/27 cases with a post-operative rate of PDE5i users increasing from 12 to 14 patients (45% vs 52%). Ultrasound aspects of BMG, recorded at every follow up visit, results in a hypoechoic plaque with an iperechoic rim that become isoechoic over the time in all cases. No case of scars or seroma was registered. Small intra-graft cystic lesions were highlighted in 3 cases (11%).Conclusions: BMG may represent a good choice in grafts procedures for PD surgical management. The functional results obtained by BMG procedures were related to the good anatomical characteristics of the patch and were highlighted in our series by use of penile ultrasound, during the follow up period.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%