In patients with stable penile deformity secondary to Peyronie's disease (PD) penile straightening can be achieved with plaque incision or partial excision and grafting. We present our experience with human cadaveric pericardium for tunica albuginea grafting for men undergoing penile reconstruction for Peyronie's disease.
We retrospectively reviewed our experience with 40 men with PD who underwent penile straightening with partial plaque excision and grafting using human cadaveric pericardium from January 1999 to January 2003.
All 40 men were evaluable for preoperative, operative and postoperative characteristics. Mean postoperative followup was 22.0 months. Mean preoperative penile curvature was 69.1 degrees. Subjectively 36 of the 40 patients (90%) graded preoperative erection as sufficiently rigid for coitus and 100% had sufficiently rigid erection for coitus following intracorporeal papaverine injection. Mean pericardial graft size was 4.9 x 4.8 cm. Postoperatively 39 of the 40 patients (98%) had successful penile straightening, 38 (95%) achieved coitus, 28 (70%) achieved full, unaided erection and 12 (30%) had some degree of erectile dysfunction (ED) requiring pharmacological assistance for intercourse. There were no significant differences in ED risk factors, plaque location, graft size or complications in men who did and did not have ED postoperatively (p >0.05). There were no major complications or graft related adverse events.
Human cadaveric pericardium is a safe, readily available and pliable tissue for tunica albuginea grafting following PD plaque incision or partial excision. Careful patient selection must be emphasized and particular attention must be given to deformity stability and preoperative erectile function to maximize surgical outcome.
"These characteristics should include good compliance and pliability, minimal inflammation, high tensile strength to prevent bulging or aneurysmal dilatation, low antigenicity risk, low infection transmission risk, availability in various sizes, packaging, and cost . Modern graft materials described in the literature include fat, vein, rectus fascia, tunica vaginalis, temporalis fascia, dermis, cadaveric dura, cadaveric pericardium, porcine small intestine submucosa (SIS), and synthetic grafts such as Dacron and Gore- Tex          . Choosing an appropriate graft material and technique is a crucial aspect for successful tunical/corporeal reconstruction and ideal functional outcome of prosthetic surgery. "
[Show abstract][Hide abstract] ABSTRACT: For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mean follow-up of 18 months (range 12 to 64), all patients had a prosthesis that was functioning properly without evidence of separation, herniation, or erosion of the graft. Sexual activity resumed at a mean time of 9 weeks (range 8 to 10). There were no adverse events related to the graft or its harvest. Use of rectus fascia graft for coverage of a tunical defect during a difficult penile prosthesis placement is surgically feasible, safe, and efficacious.
Advances in Urology 02/2008; 2008(1):370947. DOI:10.1155/2008/370947
[Show abstract][Hide abstract] ABSTRACT: Introduction: The aim of the surgical treatment in Peyronie's disease is to correct the curvature while preserving the erectile capacity of the penis. Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are; reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. Peyronie's patients with good erectile capacity are the candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered to patients without adequate erectile capacity. The present paper reviews the surgical treatment alternatives for Peyronie's patients.
[Show abstract][Hide abstract] ABSTRACT: Surgical treatment options for Peyronie’s disease include tunica shortening (Nesbit and plication) and grafting procedures. Tunica shortening procedures are associated with penile shortening. However, the amount of penile shortening is rarely significant for the patient. Although grafting procedures aim to prevent penile shortening, this may still be an issue due to the pathologic extent of Peyronie’s disease. Long-term postoperative erectile dysfunction is the major drawback. Many types of grafting material have been used, but only saphenous vein has gained certain acceptance. Grafting procedures must be restricted to patients with normal preoperative erectile status and excessive curvature. Nesbit or plication procedures may be associated with significant penile shortening. Grafting procedures are also indicated in cases of hourglass deformities, because they cannot be corrected by the Nesbit procedure. Nesbit wedge resection is still the gold standard for treating Peyronie’s disease.
Current Sexual Health Reports 06/2006; 3(2). DOI:10.1007/s11930-996-0003-9
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