Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease
Georgios Hatzichristodoulou, MD, FEBU, FECSM; Daniar Osmonov, MD; Hubert Kübler, MD; Wayne J.G. Hellstrom, MD, FACS; Faysal A. Yafi, MD, FRCSC
ONLINE: February 28, 2017 – Sexual Medicine Reviews
Peyronie’s disease (PD) is a benign fibrotic disorder marked by plaques that form within the tunica albuginea of the penis, leading to penile curvature, shortening, painful erections, erectile dysfunction (ED), and distress. Curvature can make sexual intercourse difficult.
One type of surgical PD treatment is grafting after partial plaque excision or incision. This study reviewed eleven relevant articles published between 2011 and June 2016.
Indications for Surgical Therapy
Patients are usually candidates for surgery when they have had PD for over twelve months and have been in the stable phase for six months. They must be pain free and have trouble with sexual intercourse.
Pre- and Postoperative Considerations
Patients should understand that the goal of treatment is to relieve symptoms, but treatment cannot reverse PD. They should also know that in 10% to 33% of cases, curvature returns, that penile shortening can occur, and that some men do develop ED after surgery.
Grafting Techniques and Surgical Approach
Grafting involves a plaque incision or partial excision at the point of the greatest curvature. The defect that remains on the tunica albuginea is then covered by an autologous or non-autologous graft. This technique straightens the penis.
Either an autologous or non-autologous graft is used. If an autologous graft is used, a second incision must be made to harvest the graft tissue. This takes more time and runs the risk of complications, such as wound-healing disorders, infection, scarring, pain, numbness, or lymphedema.
Because of the potential for complications, most urologists use a non-autologous (“off-the-shelf”) graft, such as pericardium, small intestinal submucosa, or collagen fleece.
To date, there is no one graft that is considered “ideal” for PD surgery. “This warrants further research to examine histologic and mechanical characteristics of the different graft materials and to evaluate clinical outcomes,” the authors wrote.
Recent Surgical Outcomes of Grafting Techniques
The authors reviewed eleven studies published between 2011 and 2016. A variety of graft types were used, including pericardium, collagen fleece, and buccal mucosa, among others. The number of patients involved ranged from 9 to 157. Rates of penile straightening ranged from 67% to 96%, with satisfaction rates ranging from 35% to 97%. (For the eight studies that provided satisfaction rates, seven reported rates over 70%.)
Patients are advised to wait four to six weeks before having intercourse. Postoperative rehabilitation might assist the recovery of erectile function, reduce the risk of penile length loss, and optimize penile straightening. Massage and stretching of the penis is recommended. Use of nocturnal phosphodiesterase type 5 (PDE5) inhibitors and external penile traction are options as well.
Surgical treatment of PD must be tailored to the patient’s needs in terms of degree of curvature, form, shape, and patient’s preoperative erectile function, the authors noted. They added that surgeon experience, careful patient selection, patient preferences, and type of deformity are factors to consider when choosing a graft type. Availability and cost of grafts may also play a role in decision making.