Grafts for Peyronie's disease: a comprehensive review

Abstract

The difficulty implicit in combining all the characteristics that an ideal patch to treat Peyronie's disease with a lengthening procedure should have, together with the challenges of comparing results from different series, means that the ideal patch has yet to be determined. Our objective with this review was to determine whether any given patch type is preferable to the others based on the evaluation of the results of published studies. A systematic search of the literature was conducted from PubMed until December 2016. Articles reporting basic research, animal research, reviews or meta-analyses and studies in children were eliminated. Series with patients undergoing some kind of other surgical intervention were only included if results were reported separately. Case reports and series of five patients were excluded. Five variables were selected to evaluate the results: number of patients, follow-up period, straightening rate, shortening rate and post-operative ED rate. For this purpose, 69 papers were included for review, and the outcomes of the use of autologous dermis, tunica vaginalis, dura mater, fascia, saphenous vein, tunica albuginea, buccal mucosa, porcine intestinal submucosa, pericardium, TachoSil and synthetic materials were presented and analysed separately. The different series published are extremely variable and heterogeneous in terms of the number of patients included, patient selection, follow-up periods, and in the measurement and interpretation of the outcomes analysed. Given these facts, it is not possible to draw any definitive conclusion, homogeneous, prospective studies using validated tools are required to determine which the ideal graft is.

Assessment of sexuality in patients with Peyronie’s disease

“…Deformation was the most frequent symptom in our study in 70% in the fl accid state and 100% in the erection caused by the injection of the "Prostaglandin E2", 80% of which had a non-complex curvature, these data are similar to those in the literature where the curvature varies from 65 to 100% [17,18]. The deformation occurs next to the fi brous plaque or nodule [19]. The intensity and severity of this pain varies depending on the duration of the disease, the extent of the alteration of the penile shape and different positions around sexual intercourse [20].…”

Peyronie’s disease: Contemporary evaluation and management

“…Therefore, synthetic grafts are no longer advocated as first‐line treatment. PD grafts can be generally categorized into autologous and non‐autologous materials 35,118,119 . Autologous grafts, such as dermis, saphenous vein, oral mucosa, tunica vaginalis and fascia lata, are readily available and do not pose the theoretical risk for graft rejection.…”

“…Successful penile straightening, defined by some authorities as a “functionally straight” penis with residual curvature <20–30°, is often based on subjective reporting. Success rates range from 55 to 100%, and this might actually decrease over time 118,121 . Patient satisfaction rates, which take into account not only straightness, but also other aspects, such as postoperative penile length and erectile function, are similarly variable, ranging from 60 to 100% 35 .…”

“…Patient satisfaction rates, which take into account not only straightness, but also other aspects, such as postoperative penile length and erectile function, are similarly variable, ranging from 60 to 100% 35 . Postoperative complications that compromise patient satisfaction include perceived penile shortening (0–90%) and penile sensory changes (0–22%) 35,118,122 . Sensory changes are transient in the majority of patients, and a recent report from Terrier et al.…”

“…Arguably, the most feared postoperative complication is ED, which is reported in 0–63% in modern series 35,118 . Suggested risk factors include greater penile curvature, older age and larger graft size 110,125 .…”