UroToday - Plaque Incision and Fascia Lata Grafting Examined for the Management of Peyronie’s Disease

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Peyronie's Disease

Plaque Incision and Fascia Lata Grafting Examined for the Management of Peyronie’s Disease

Tuesday, 12 September 2006

BERKELEY, CA (UroToday.com) - Peyronie's disease (PD) is a localized connective tissue disorder that can result in penile pain, penile angulation, penile shortening, erectile dysfunction (ED) and a palpable plaque. The Nesbitt procedure can correct curvature but often results in penile shortening. To address this problem, plaque excision and grafting has been performed with a multitude of materials but can lead to ED after surgery. Plaque incision and venous grafting (the Lue procedure) has become an option to reduce the risk of post-op ED. Using a vein graft necessitates a second operative incision which can increase morbidity and lengthen the operation.

A recent paper examined the technique of plaque incision and grafting with a commercially available, "off-the-shelf" human fascia lata graft (Tutoplast, Mentor Corp). The paper, by J. S. Kalsi and colleagues from London, is published in the July 2006 issue of BJU International.

Over a four-year period, 14 patients with Peyronie's disease underwent plaque incision followed by grafting with Tutoplast. Seven patients reported ED prior to surgery, but all had success with PGE-5 inhibitors or intracavernosal therapy. Three patients had a previously unsuccessful Nesbit procedure. The mean angle of penile curvature was 67 degrees (20-90). The stretched penile length was measured before and after surgery in all patients.

The technique of plaque incision involves an "I" shaped transverse incision at the point of maximum curvature. The incision springs open and the graft is sutured in with 3/0 PDS sutures. Ten men required only one incision and graft, while 3 men had two grafts, and one man required three separate incisions and grafts. Six patients required additional plication sutures to achieve a straight penis.

Analysis of the results showed an overall satisfaction that was "excellent or satisfactory' in 13 of 14 men. With a mean follow-up of 31 months, the penis was completely straight in 11 of 14 patients. After surgery, one patient developed de novo ED which was being successfully managed with intracavernosal injections. In 10 patients, there was no penile shortening noted after surgery. Four patients reported penile shortening of > 1 cm. The mean loss of length was 0.86 cm in the series as a whole.

Fascia lata Tutoplast grafts seem to provide a reliable and well tolerated biomaterial for penile reconstruction in Peyronie's disease. The "off-the-shelf" availability eliminates donor site morbidity and appears to only cause a small amount of penile shortening due to graft contracture.

Jas S. Kalsi, Nim Christopher, David J. Ralph and Suks Minhas

BJU Int. 2006 July;98(1):110-15