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. 2017 Aug;6(4):645-656.
doi: 10.21037/tau.2017.07.17.

Peyronie's graft surgery-tips and tricks from the masters in andrologic surgery

Georgios Hatzichristodoulou  1 , Peter Tsambarlis  2 , Hubert Kübler  1 , Laurence A Levine  2
Affiliations

Peyronie's graft surgery-tips and tricks from the masters in andrologic surgery

Georgios Hatzichristodoulou et al. Transl Androl Urol. 2017 Aug.

Abstract

Background: Grafting techniques in the surgical management of Peyronie's disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD.

Methods: This report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed.

Results: Adequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy.

Conclusions: The present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.

Keywords: Complications; Peyronie’s disease (PD); grafting techniques; grafts; surgical outcomes; surgical technique; surgical therapy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Sealing technique: Penile deviation 80° dorsal with indentation, aspect after penile degloving and preparation of neurovascular bundle.
Figure 2
Figure 2
Sealing technique: Defect of tunica albuginea after partial plaque excision.
Figure 3
Figure 3
Sealing technique: Sealing of tunical defect with collagen fleece (TachoSil®).
Figure 4
Figure 4
Sealing technique: Complete straightness of penis, result at end of surgery.
Figure 5
Figure 5
PEG procedure: Elevation of Buck’s fascia.
Figure 6
Figure 6
PEG procedure: Plaque excision.
Figure 7
Figure 7
PEG procedure: Placement of stay sutures and measurement of the defect.
Figure 8
Figure 8
PEG procedure: Graft secured in place.
See this image and copyright information in PMC

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