Corporoplasty using bovine pericardium grafts in complex penile prosthesis implantation surgery

Lopes, Eduardo José Andrade; Kuwano, André Yoichi; Guimaraes, Andreia N.; Flores, Jesuino P.; Jacobino, Modesto

doi:10.1590/s1677-55382009000100008

Cited by 18 publications

(6 citation statements)

References 19 publications

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“…Seven patients required reduced diameter devices (AMS 700 CXM™), while two received standard sizes (AMS 700 CX™). Mean length of excised fibrotic corporal segments was 5.2 cm (range 4-7), and mean PP cylinder length was 13.8 cm (range [12][13][14][15][16]. No patient required grafting, and all patients reported limited thrusting with intercourse, presumably due to inadequate functional penile length.…”

Section: Results Of Corporal Tissue Excavationmentioning

confidence: 99%

“…Optimal strategies to identify patients at high risk for corporal fibrosis have not been described. Anecdotally, and based on prior descriptions of cohorts, cases of prior penile infection with device removal and ischemic priapism represent some of the conditions more likely to result in severe fibrosis [6,8,12]. However, even in these settings, significant portions of nonfibrotic tissue may be encountered.…”

Section: Resultsmentioning

confidence: 99%

“…Although this permitted device placement in the majority of cases, it frequently was time consuming and included the use of synthetic graft materials, which subsequently fell out of favor due to high revision and infection rates. Later descriptions of autologous, xenologous or cadaveric allografts demonstrated successful placements in all patients, with many able to receive standard‐sized implants primarily [2,3,11,12,14]. Revisions range from 0% to 22% and satisfaction 71% to 100% at follow‐ups of 10–91 months.…”

Section: Resultsmentioning

confidence: 99%

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Critical Appraisal and Review of Management Strategies for Severe Fibrosis During Penile Implant Surgery

Trost

Patil

Kramer

2015

The Journal of Sexual Medicine

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Introduction Penile corporal fibrosis represents a challenging clinical scenario for surgeons placing penile prostheses (PP). Because of its rarity, a small number of series with limited follow-up have reported outcomes in this cohort. Aim The aim of this study was to perform a critical appraisal of the corporal excavation technique, discuss its relevance to contemporary practice, and review alternative surgical methods and outcomes. Methods A critical review was performed of the 2006 article by Montague and Angermeier, “Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis.” Notable inclusions and omissions were described, with emphasis placed on methodology and outcomes. A PubMed search from 1990 to June 2015 was then performed to review and summarize the literature on managing corporal fibrosis during PP surgery. Main Outcome Measures The main outcome measures used were the major contributions and limitations of the 2006 article describing outcomes of the corporal excavation technique. Results Corporal excavation is a relevant surgical technique for managing severe corporal fibrosis. Compared with alternatives, excavation achieves successful placement of PP without need for grafting and with few complications. The article was limited by several notable omissions including relevant patient demographic and disease characteristics, patient selection, and minimal descriptions of complications and outcomes. Alternative techniques include use of specialized dilators, counter incisions, reconstruction with graft placement, minimal scar tissue excision, and endoscopic resection. Because of limited data, no specific algorithm for managing corporal fibrosis can be prescribed. Conclusions Corporal fibrosis is a challenging clinical scenario and requires surgical experience and specialized techniques to manage appropriately. Corporal excavation represents one of several viable techniques, which may be chosen based on surgeon’s preference and clinical factors.

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Section: Results Of Corporal Tissue Excavationmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Critical Appraisal and Review of Management Strategies for Severe Fibrosis During Penile Implant Surgery

Trost

Patil

Kramer

2015

The Journal of Sexual Medicine

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“…Although the use of patch grafts to cover limited tunical defects after the implantation of a penile prosthesis in patients with severe fibrosis has been already described, this is the largest series of simultaneous total corporeal reconstruction and insertion of erectile devices reported so far (Table 2) [20–24].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Total Corporal Reconstruction and Implantation of a Penile Prosthesis in Patients with Erectile Dysfunction and Severe Fibrosis of the Corpora Cavernosa

Sansalone

Garaffa

Djinovic

et al. 2012

The Journal of Sexual Medicine

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Introduction Implantation of a penile prosthesis in severely scarred corporal bodies represents a great challenge as fibrosis can compromise dilatation and subsequent closure of the corpora cavernosa and limit size, type, and function of the device. Aim The aim of this study is to report our experience of simultaneous corporeal reconstruction and penile prosthesis implantation in patients with severe penile contracture consequence of diffuse fibrosis. Methods Between March 2006 and February 2010, 18 patients with severe penile contracture and coporeal fibrosis underwent simultaneous corporeal reconstruction and placement of a penile prosthesis. Main Outcome Measures Surgical outcome and complications have been recorded during postoperative follow-up. Patients’ satisfaction has been assessed 6 months postoperatively with the administration of the modified Erectile Dysfunction Index of Treatment Satisfaction questionnaire. Results Although the dilatation of the corpora was extremely difficult due to the severe fibrosis, a penile prosthesis has been implanted in all patients. A malleable penile prosthesis has been inserted in four patients and a three-piece inflatable device in the remainder. After an average follow-up of 26 months (range 6–36), revision surgery was required in four patients (elective exchange to three-piece inflatable device in three patients and upsizing of the implant in one patient). Although all patients were able to achieve penetrative sexual intercourse, four patients were partially dissatisfied because of significant penile shortening. Conclusion In expert hands, simultaneous penile prosthesis implantation and corporal reconstruction of severely scarred corpora yield satisfactory results. Patients must be warned that complication rate in presence of severe fibrosis is significantly higher than in virgin cases and that downsized cylinders might be required due to the contracture of the tunica albuginea.

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“…Of those, there were 16 studies on patients with Peyronie's disease and/or penile straightening [9, 26, 30, 32-36, 39, 43-47, 49, 50], 3 reports on penile prosthesis complications [10,38,41], and 1 case of congenital chordee of the penis [40]. There were 2 reports of urethral reconstruction with successful outcomes and no complications [37,42].…”

Section: Human Studiesmentioning

confidence: 99%

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

Hosseini

et al. 2018

Urol Int

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Introduction: The use of pericardium has been expanded into different surgical modalities; however, there are scarce data regarding the feasibility of the pericardium in reconstructive urologic surgeries. We systematically reviewed the literature on the effectiveness of the pericardial tissue for reconstructive urologic surgeries. Materials and Methods: PubMed and Scopus were searched online for evidence on the use of the pericardium in urologic surgeries. Through the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 38 of 4,071 studies were identified. Results: A total of 715 patients and 139 animals underwent reconstructive urologic surgeries using the pericardium. Bladder, urethral, and renal reconstructions were successful in 100% of the human cases. The rates of dissatisfaction, glans hypoesthesia, and penile shortening were comparable between the pericardial graft surgeries and the other operations during penile straightening, but there was a trend among the patients with pericardial grafts toward having a more penile curvature at follow-up (risk ratio [RR] 2.03, 95% CI 0.90–4.61, p = 0.09; I² = 0%). Among the animal studies, there were 4 reports of penile reconstruction, 7 studies of bladder reconstruction, and 1 study of urethroplasty. Bladder reconstruction and urethroplasty were successful in 83 and 20% of the animals, respectively. The pooled result of the stimulated intracorporeal pressure 5 V significantly favored pericardial grafts during penile reconstruction (RR 2.61, 95% CI 1.26–3.97, p = 0.0002; I² = 0%). Conclusions: Our systematic review demonstrates the feasibility of the pericardium, regardless of its type, in urologic surgeries. It, however, seems that urethral substitution needs further investigation. Given the lower cost, easier handling, and less immunogenicity of the pericardium, further studies are required to examine its pros and cons.

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Corporoplasty using bovine pericardium grafts in complex penile prosthesis implantation surgery

Cited by 18 publications

References 19 publications

Critical Appraisal and Review of Management Strategies for Severe Fibrosis During Penile Implant Surgery

Critical Appraisal and Review of Management Strategies for Severe Fibrosis During Penile Implant Surgery

Simultaneous Total Corporal Reconstruction and Implantation of a Penile Prosthesis in Patients with Erectile Dysfunction and Severe Fibrosis of the Corpora Cavernosa

Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and Meta-Analysis

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