The use of plaque incision and graft techniques (PIG) for the treatment of severe Peyronie's disease (PD), may lead to erectile dysfunction (ED); graft size is 1 of the contributing factors for post-PIG ED. Recently the iGrafter software APP was introduced using a mathematical algorithm to distribute the incisions along the penile length resulting in a smaller grafting area.
Compare 2 PIG techniques, the Double-Y(DY) and iGrafter, in 3 main aspects: (i) Total grafting area; (ii) The variation in calculating the grafting to be used; (iii) time to perform the PIG.
Six urologists with expertise in sexual medicine performed both techniques twice using four 3-D validated training models for PD with a standard 60° uniplanar dorsal curvature.
The graft areas and operative partial and total time for each step of the operation were recorded for each procedure. Unpaired t-test and the coefficient of variation for graft area across surgeons was calculated comparing both techniques.
For all surgeons, the use of iGrafter resulted in 2 grafts, for the DY technique in 1 graft. Overall, TT for the iGrafter was significantly longer than for DY technique (49.4 ± 11 vs 40.7 ± 5.7 minute; P = .02), The iGrafter grafting area was significantly smaller (11.6 ± 1.2 vs 23.3 ± 5.4 cm2; P: .01), representing a 50.2% area reduction when compared to the DY. The variation of graft area, using the iGrafter also yielded a more consistent graft across all surgeons (CV = 10.56% vs 23.28%).
The iGrafter, when compared to DY technique, reduced the graft area by 50%, which potentially means less erectile dysfunction.
Our study eliminates anatomical variations found in a real clinical case making it possible to compare surgical techniques with the same penile anatomy. However, the 3D-printed model cannot replicate the living human tissue property preventing a simulation close to actual surgery.
The use of the iGrafter software for PIG surgery has shown to be a promising technique for severe PD management resulting in smaller graft size (about 50% smaller when compared to the DY), although it might be more time-consuming. Tourchi A, Nascimento B, de Freita Miranda A, et al. Grafting Area Reduction in Peyronie's Disease Surgery: Comparative Assessment Between Double Y Vs iGrafter APP Using 3D-Printed Penile Models. J Sex Med 2021;XX:XXX-XXX.
The journal of sexual medicine. 2022 Feb 23 [Epub ahead of print]
Ali Tourchi, Bruno Nascimento, Alexandre de Freitas Miranda, Eduardo Miranda, José Bessa, William C Nahas, Rogério Sayão Filho, Miguel Srougi, Bruno Machado
Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Department of Urology, Universidade de São Paulo, São Paulo, São Paulo, Brazil., Department of Urology, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brazil., Department of Surgery, Urology Division, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil., Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: .