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

Grafts in Peyronie's surgery without the use of prostheses: a systematic review and meta-analysis

ABSTRACT

Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.

Comparison of technical success and adverse events of plaque incision and grafting methods in patients with Peyronie's disease: Tunica vaginalis versus buccal mucosa

OBJECTIVE

To compare the clinical outcomes of Peyronie's disease (PD) patients who were treated by plaque incision and grafting either with tunica vaginalis (TV) or buccal mucosa (BM) grafts.

METHODS

PD patients in BM (n=20) and TV group (n=20) were recruited between 2013 and 2020. Erectile dysfunction was assessed by short form of International Index of Erectile Function Questionnaire (IIEF-5). Technical success was defined as residual curvature ≤15°. Penile Doppler ultrasound was performed at baseline evaluation, 3-, and 24 months. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in erect penis. Erect penile length and curvature angle were measured at baseline and at 3, 12, and 24 months.

RESULTS

Mean age of the groups was comparable (47.2±10.8 years in TV vs 46.5±9.9 years in BM groups). Baseline mean penile curvature was 48.0±6.6° (TV) and 50.3±11.6° (BM) (p<0.001). Mean residual curvature at 24-months visits was 12.4±4.9° (TV) and 7.9±3.7° (BM), not significantly different. Technical success rate was 90% for both groups at 24 months. Surgery significantly increased erect penile length in both groups. Mean preoperative IIEF-5 scores were 18.4±2.5 and 17.5±2.2 in TV and BM groups, respectively. In both groups, IIEF-5 scores significantly improved after surgery with no intergroup IIEF-5 difference (20.6±2.6 in TV and 21.3±2.2 in BM). Mean postoperative PSV significantly increased, EDV significantly decreased in both groups, however, there was no significant intergroup difference.

CONCLUSION

Both grafting materials provided similar beneficial effects regarding technical success, erectile dysfunction, and penile length.

Core urological surgical training: The pivotal role of feminizing genital reconstruction for gender dysphoria

Not available.

The use of a polyglycolic acid polymer graft in Peyronie's disease - preliminary outcomes

OBJECTIVE

Plaque incision and grafting is indicated for patients with Peyronie's Disease [PD] and severe curvature, complex deformities or for patients with significant penile shortening. To date, no graft studied has been considered ideal. The aim of this study is to conduct a descriptive analysis about functional results with the use of a bioabsorbable graft for PD treatment.

MATERIALS AND METHODS

A single-center, retrospective evaluation of a cohort of patients who were treated by plaque incision and grafting with a polyglycolic acid polymer graft (Gore® Bio-A®) between 2018 and 2021 was conducted. Correction of penile curvature was the main outcome. Loss of penile sensitivity, de novo erectile dysfunction and any other adverse event were the secondary endpoints.

RESULTS

14 patients were included in this study (mean age 59.5 ± 7.2 years). The median follow-up time was 12 months (range 3-12). The curvature correction rate was 78.5%. Glans hypoesthesia was present in one of 14 patients (7.1%) and refractory erectile dysfunction was reported in 64.2%. None of the patients presented any major adverse event based on Clavien-Dindo classification.

CONCLUSIONS

Curvature correction and changes in penile sensitivity rates were similar to those found in the literature. No major surgical complications, such as graft rejection, infection, and extrusion, occurred in this sample. Although a population with a higher prevalence of erectile dysfunction was included in this sample, higher rates of refractory erectile dysfunction were observed and these findings should be confirmed in further studies.

Urologists' knowledge base and practice patterns in Peyronie's disease. A national survey of members of the italian andrology society

Peyronie's disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases.

OBJECTIVE

Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA).

METHODS

Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries.

RESULTS

The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques.

CONCLUSIONS

The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease's etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.

Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft

BACKGROUND/AIM

We aimed to evaluate the effectiveness and safety of penile plaque incision and buccal mucosa grafting in patients with stable-phase Peyronie's disease (PD).

METHODS

This was a prospective evaluation of patients with stable-phase PD who were treated by plaque incision and buccal mucosa grafting. Preoperative evaluation included International Index of Erectile Function Questionnaire (IIEF-5), measurement of erect penile length, and penile Doppler ultrasound during prostaglandin-induced erection. At 3- and 24-month follow-up visits, penile length and residual curvature were measured along with penile Doppler ultrasound and IIEF5 questionnaires. Patient and sexual partner satisfaction were also assessed at 24-month-visit.

RESULTS

The study was completed with 20 patients (mean age 46.5 ± 9.9 years). Dorsal curvature was the most frequent site of curvature (45%). The median curvature at preoperative evaluation was 45°(range 40-90°). The postoperative median curvatures were 5°(5-10, IQR) and 7°(5-10, IQR) at 3- and 24-month postoperatively, respectively. Success rate was 95% at 3-month and 90% at 24-month. There was no significant penile shortening. The mean IIEF-5 score was 17.5 ± 2.2 at preoperative evaluation. The median IIEF-5 scores were calculated as 20.1 ± 2.2 and 21.3 ± 2.2 at 3-month and 24-month visits, respectively (p<0.0001). Compared with baseline IIEF-5 score, both postoperative IIEF-5 scores were significantly higher. There was no de novo erectile dysfunction. There were no serious complications during and after the surgery. Ten percent of patients were poorly satisfied with the results of the surgery.

CONCLUSION

Corporoplasty with buccal mucosa graft led to excellent structural and functional results and patient satisfaction. Ainayev Y, Zhanbyrbekuly U, Gaipov A, et al. Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft. J Sex Med 2021;18:1308-1316.