Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

INTRODUCTION - Penile curvature correction with plaque incision and graft (PIG) increases the risk of erectile dysfunction (ED) and is associated with mechanical and geometric abnormalities.

AIMS - The aim of this study was to create and validate a new PIG technique using minimum graft area to correct simple or complex penile curvature with or without hourglass deformity, while avoiding mechanical and geometric abnormalities.

METHODS - Using our cotton fabric model, we created a mathematic solution for PIG with no residual defects. This was applied in nine men who had sufficient penile rigidity while penetrating their respective partners. They underwent fascia lata patch corporoplasty using the new developed technique (iPad [Apple Corp, Palo Alto, CA, USA] app: iGrafter). Subjects answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire preoperatively and at the end of follow-up.

MAIN OUTCOME MEASURES - The main outcome measures used were patient demographics, erectile function, residual curvature, patient satisfaction, graft area, and complications.

RESULTS - After a mean follow-up of 17. 8 months, no significant complication was noted. Complete penile straightening was achieved in all patients. The short side of the penis increased a mean of 3 cm in length, and the mean graft area was 12. 4 cm(2). At the end of the follow-up, three patients developed recurrent deformity. One patient presented severe fibrosis in the corpora cavernosa and severe ED. There was no significant difference between the mean preoperative and postoperative IIEF-5 scores (20. 6 vs 19. 4, respectively). At the end of follow-up, all patients were able to have sexual intercourse (two with and seven without pharmacological aid). Eight of the nine patients were satisfied with the surgical result.

CONCLUSIONS - Penile curvature surgical correction using the iGrafter seems to be an efficient and safe procedure, which uses minimum graft area and preserves erectile function after penile rectification, without resulting in residual deformities. Further research is needed to confirm the efficacy of this procedure.

Sexual medicine. 2016 Jan 11 [Epub ahead of print]

Alexandre F Miranda, Francisco J B Sampaio

Ministry of Health, Ipanema Federal Hospital, Rio de Janeiro, Brazil; Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.  Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil.