Postoperative Progress of Deep Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie's Disease: Prospective Observational Study for 3 Years

Abstract

Purpose: Despite recent popularity, partial plaque excision and sealing with TachoSil has concern about tunica regeneration from graft and lack of long-term results. Previously, we introduced multiple deep grid incisions of Peyronie's plaque to minimize tunical defect with consequent veno-occlusal erectile dysfunction. To assess the efficacy of modified grid incision of plaque and sealing with collagen fleece in postoperative progress of 34 patients for 3 years.

Materials and methods: From Aug 2018, 34 patients with stable Peyronie's disease (PD) underwent surgery involving three major steps: 1) dissection of the neurovascular bundle or urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete curvature correction, and 3) sealing with collagen fleece without suture. We assessed the stretched penile length, totally straightness, penile sonography, erectile function preoperatively and 3, 6, 12 months and annually postoperatively. This study was approved by the Institutional Review Board.

Results: Mean age was 59.4 years (29-72 years). Mean curvature was 53.5 degree (35-100 degree), with hinge and hourglass deformity in 12 and 8 patients, respectively. Five patients required inflatable penile prosthesis (IPP) insertion, with one more at 30 months. The mean follow-up was 42.3 months. Penile rehabilitation, including daily massage, reduced subcutaneous thickening by 12 months postoperatively. All patients initially achieved complete straightness, with two experiencing recurrent curvature. Four patients had subcutaneous hematomas, subsiding in two. Minor skin issues occurred in three IPP patients. Postoperative erectile function was satisfactory in 85.0% of patients. Most regained preoperative length by 1.6 years. Global Assessment Questionniare satisfaction increased from 69.0% at 1 year to 90.0% until 3 years.

Conclusions: The modified grid incision with collagen fleece sealing effectively treats PD without causing tunica albuginea defects. Long-term follow-up is essential for monitoring erectile function and penile length recovery, ensuring successful clinical outcomes.

Keywords: Collagen; Incisions; Penile induration; Postoperative period; TachoSil.

Fig. 1. Representative figures of Deep Grid Incision of Plaque and Sealing with TachoComb. (A) Preoperative feature of dorsal curvature with hinge deformity. (B) Deep grid incision for complete correction of curvature and to reveal cavernosal tissue (neurovascular bundle and urethra hold with babcock clamp and loop). (C) Sealing with collagen fleece.

Fig. 2. Thickness of subcutaneous TachoSil decreased and breakage of tunica albuginea reunited on follow-up sonography. (A) Preoperative subcutaneous thickness. (B) Immediate postoperative state, thick enhanced penis. (C) Changes of subcutaneous thickness, postoperative 3, 6, and 12 months, respectively. (D) Sliced tunical lump at postoperative 3 month renited at base until 12 months on follow-up sonography 3, 6, and 12 months postoperative

Fig. 3. Multiple longitudinal incision enables insertion of cylinder into narrow fibrotic corporal body with severe hinge and bottle neck deformity successfully.

Fig. 4. Modified grid incision on multiplanar curvature enables insertion of inflatable penile prosthesis cylinder into fibrotic narrow corporal body successfully. (A) Preoperative. (B) Erection test at operation room. (C) End of operation at operation room. (D) Postoperative 6 month.