Surgical management algorithm for complex cases of Peyronie’s Disease with penile prosthesis implantation, modified neurovascular bundle release and single or multiple corporeal incisions and grafting with collagen fleece
Fernández-Pascual, E1; González-García, J2; Rodríguez-Monsalve, M1; García-Criado, E1; Turo, J1; Martínez-Ballesteros, C1; Carballido, J1; Martínez-Salamanca, JI1
1: Hospital Universitario Puerta de Hierro Majadahonda, Spain; 2: Hospital Central de la Cruz Roja San José y Santa Adela, Spain
Objectives: Surgery is the mainstay of treatment for Peyronie’s disease (PD), but multiple surgical approaches may be considered. We present a new algorithm for the surgical management of complex cases of PD, which suggests specific surgical techniques for each individual case. We aim to demonstrate its safety and effectivity for penile curvature correction and restoring erectile dysfunction with limited complications.
Patients and methods: Data were collected from a prospective cohort of 23 consecutive patients treated in our institution with complex PD and ED, between February 2015 and May 2017. The surgical procedure consists of an implantation of penile prosthesis (malleable or inflatable) associated with single or multiple incisions of the plaque/tunica albuginea and grafting with a self-adhesive collagen fleece, and previously modified neurovascular bundle release. Descriptive statistics were calculated for demographic data, preoperative clinical information and follow-up variables. All patients provided informed consent and the protocol was approved by Institution Review Board (IRB).
Results: With a median follow-up of 15.3 months, the mean postsurgical penile lengthening was 2.7(1-5) cm, with an improvement of PDQ PD bother score of 4.3(2-5) points. No glans ischemia or infectious complications were recorded, but hematoma was observed in 26% patients, and the overall satisfaction was 92%.
Conclusions: The implantation of penile prosthesis (malleable or inflatable) associated with single or multiple incisions of the plaque/tunica albuginea and grafting with a self-adhesive collagen-fibrin fleece proves to be a safe and efficient alternative for patients with complex PD who suffered from significant shortening and erectile dysfunction. We plan to validate this algorithm with larger and multicenter studies and increase its use in the future.
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