Presentation Authors: Afonso Castro, Pedro Simoes de Oliveira, Jose Dias, Tome Lopes, Francisco Martins*, Lisbon, Portugal
Introduction: Penile curvature is in the majority of patients the primary endpoint in the treatment of Peyronieâ€™s disease. The aim of this video is to present a technique of multiple transverse incisions patched with TachoSilÂ® self-adhesive collagen fleece (Takeda, Portugal) for the primary surgical correction of penile dorsal or dorsolateral curvature, regardless of severity of angle of curvature and penile length, as an alternative to grafting and plicating procedures.
Methods: A duplex Doppler ultrasound is performed routinely pre-operatively to assess erectile hemodynamics. A subcoronal circumferential incision is made and penile shaft degloving is performed as necessary. The neurovascular bundle is carefully elevated off from the area of maximal curvature. Several transverse incisions are marked and then made with a cold scalpel on the tunica albuginea about 3 mm apart from each other. The tunical incisions are then sealed with TachoSilÂ® separately with the penis on stretch to avoid potential contraction. No stitching is necessary as this vascular sealant sticks to the tunical defect by itself. The neurovascular bundle and Buckâ€™s fascia are repositioned and sutured back in place.
Results: The multiple dorsal transverse incision technique was used in 11 patients, aged 47-76 years (mean 64). Penile curvature varied from 45Âº to 90Âº (mean 65Âº). PSV varied from 44 cm/s to 82 cm/s (mean 57) and EDV from -1.5 cm/s to 10.8 cm/s (mean 4.5). Operative time ranged from 75 min to 120 min (mean 95). Mean follow-up varied from 4 to 13 months (mean 5). Post-operative residual curvature was less than 15Âº in 3 patients. All patients were satisfied with the surgical results, especially with penile straightening, rigidity and erogenous sensitivity.
Conclusions: We think this procedure is safe, efficacious and associated with patientsâ€™ high satisfaction rate and may be indicated in all patients with dorsal/dorsolateral curvature, regardless of severity of angle of curvature, with no or minimal impact on erectile function and penile length. The use of simple incisions only and TachoSilÂ® seems to avoid the potential adverse effects of veno-occlusive dysfunction created by the large grafted tunical defects and the frustrating complication of penile length decrease.