madman
Super Moderator
Summary
Introduction: Plaque incision and grafting represent the best surgical approach to Peyronie’s Disease (PD). The grafting procedures must be restricted to patients with normal preoperative status, excessive curvature, and/or deformities. However, the ideal graft has not been identified yet. Buccal mucosa grafts (BMG) provided excellent short-term results, ensuring the fast return of spontaneous erections and preventing shrinkage, which is the main cause of graft failure. Another fearsome surgical complication is de novo erectile dysfunction (ED). We report our results with BMG focusing on the analysis of ultrasonographic and clinical data demonstrating buccal mucosa as a determinant factor that allows avoiding complications.
Materials and methods: From 2013 to 2019 we performed at our Urology Unit 27 corporoplasties with BMG to correct complex penile curvature due to PD. Clinical, post-surgical, and ultrasound follow-up data were evaluated. All patients were no responders to medical treatment or previous surgical procedures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history, and penile dynamic ultrasound (PGE1-induced erection) were collected. The time of spontaneous erection resumption was recorded for each patient. To improve blood supply to the graft, a low-dose PDE5-i was prescribed for all patients for a period of two months, starting immediately after discharge. Check-ups were scheduled every 3 months, starting from 1 month after surgery. In each visit, patients underwent a penile ultrasound evaluation of graft features. After 6 and 12 months, all patients underwent a penile dynamic ultrasound for Erection Hardness Score determination, then a standard ultrasound and clinical evaluation yearly. Our analyses were focused on BMG as a major determinant of surgical success.
Results: Mean age of 27 patients was 57 years (42-71) with a maximum follow-up time of 72 months and a minimum of 3. The site of penile curvature was dorsal in 18 (67%) patients, ventral in 2 (7%), complex in 7 (26%). The degree of the curvature was < 60° in 11 (41%) patients, > 60° in 16 (59%). Straightening of the penis was reached in 100% of cases. Penile shortening resulted in 7.4% (2/27). De novo ED appeared in 2/27 cases with a post-operative rate of PDE5i users increasing from 12 to 14 patients (45% vs 52%). Ultrasound aspects of BMG, recorded at every follow-up visit, results in a hypoechoic plaque with an iperechoic rim that becomes isoechoic over time in all cases. No case of scars or seroma was registered. Small intra-graft cystic lesions were highlighted in 3 cases (11%).
Conclusions: BMG may represent a good choice in grafts procedures for PD surgical management. The functional results obtained by BMG procedures were related to the good anatomical characteristics of the patch and were highlighted in our series by use of penile ultrasound, during the follow-up period.
INTRODUCTION
Peyronie’s disease (PD) is a benign condition causing penile deformities, shortening, loss of penile flexibility, and sexual dysfunctions (1). The diagnoses are increasing in number, even in the younger population, because of the increased knowledge about the topic (2). Surgical treatment remains the gold standard and it includes penis plication, grafting, and placement of inflatable prosthesis with the aim to restore coital functions (3). Buccal mucosa grafts (BMG) provided excellent short-term results, suggested by the early recovery of spontaneous erections and the prevention of late shrinkage, which is the main cause of graft failure. It also seems to be safe and reproducible, thus representing a valuable treatment option for PD. Clinical series are limited yet but functional and cosmetics results are very promising (4). We analyzed our surgical results with the BMG technique applied to 27 patients focusing on the ultrasonographic follow-up and clinical data.
CONCLUSIONS
The functional results obtained by BMG procedures in PD surgical treatment was related to the great anatomical characteristics of the patch and highlighted in our series by use of penile ultrasound during the follow-up period. Ultrasound features confirmed the characteristics of buccal mucosa as a perfect seal in the tunica albuginea defect, created after fibrotic plaque incision, allowing to reduce the risk of de novo ED.
Introduction: Plaque incision and grafting represent the best surgical approach to Peyronie’s Disease (PD). The grafting procedures must be restricted to patients with normal preoperative status, excessive curvature, and/or deformities. However, the ideal graft has not been identified yet. Buccal mucosa grafts (BMG) provided excellent short-term results, ensuring the fast return of spontaneous erections and preventing shrinkage, which is the main cause of graft failure. Another fearsome surgical complication is de novo erectile dysfunction (ED). We report our results with BMG focusing on the analysis of ultrasonographic and clinical data demonstrating buccal mucosa as a determinant factor that allows avoiding complications.
Materials and methods: From 2013 to 2019 we performed at our Urology Unit 27 corporoplasties with BMG to correct complex penile curvature due to PD. Clinical, post-surgical, and ultrasound follow-up data were evaluated. All patients were no responders to medical treatment or previous surgical procedures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history, and penile dynamic ultrasound (PGE1-induced erection) were collected. The time of spontaneous erection resumption was recorded for each patient. To improve blood supply to the graft, a low-dose PDE5-i was prescribed for all patients for a period of two months, starting immediately after discharge. Check-ups were scheduled every 3 months, starting from 1 month after surgery. In each visit, patients underwent a penile ultrasound evaluation of graft features. After 6 and 12 months, all patients underwent a penile dynamic ultrasound for Erection Hardness Score determination, then a standard ultrasound and clinical evaluation yearly. Our analyses were focused on BMG as a major determinant of surgical success.
Results: Mean age of 27 patients was 57 years (42-71) with a maximum follow-up time of 72 months and a minimum of 3. The site of penile curvature was dorsal in 18 (67%) patients, ventral in 2 (7%), complex in 7 (26%). The degree of the curvature was < 60° in 11 (41%) patients, > 60° in 16 (59%). Straightening of the penis was reached in 100% of cases. Penile shortening resulted in 7.4% (2/27). De novo ED appeared in 2/27 cases with a post-operative rate of PDE5i users increasing from 12 to 14 patients (45% vs 52%). Ultrasound aspects of BMG, recorded at every follow-up visit, results in a hypoechoic plaque with an iperechoic rim that becomes isoechoic over time in all cases. No case of scars or seroma was registered. Small intra-graft cystic lesions were highlighted in 3 cases (11%).
Conclusions: BMG may represent a good choice in grafts procedures for PD surgical management. The functional results obtained by BMG procedures were related to the good anatomical characteristics of the patch and were highlighted in our series by use of penile ultrasound, during the follow-up period.
INTRODUCTION
Peyronie’s disease (PD) is a benign condition causing penile deformities, shortening, loss of penile flexibility, and sexual dysfunctions (1). The diagnoses are increasing in number, even in the younger population, because of the increased knowledge about the topic (2). Surgical treatment remains the gold standard and it includes penis plication, grafting, and placement of inflatable prosthesis with the aim to restore coital functions (3). Buccal mucosa grafts (BMG) provided excellent short-term results, suggested by the early recovery of spontaneous erections and the prevention of late shrinkage, which is the main cause of graft failure. It also seems to be safe and reproducible, thus representing a valuable treatment option for PD. Clinical series are limited yet but functional and cosmetics results are very promising (4). We analyzed our surgical results with the BMG technique applied to 27 patients focusing on the ultrasonographic follow-up and clinical data.
CONCLUSIONS
The functional results obtained by BMG procedures in PD surgical treatment was related to the great anatomical characteristics of the patch and highlighted in our series by use of penile ultrasound during the follow-up period. Ultrasound features confirmed the characteristics of buccal mucosa as a perfect seal in the tunica albuginea defect, created after fibrotic plaque incision, allowing to reduce the risk of de novo ED.
