Suture-Free Sealing of Tunical Defect with Collagen Fleece after Partial Plaque Excision in 319 Consecutive Patients with Peyronie's Disease: The Sealing Technique

Hatzichristodoulou, Georgios; Fiechtner, Scarlet; Pyrgidis, Nikolaos; Gschwend, Jürgen E.; Sokolakis, Ioannis; Lahme, Sven

doi:10.1097/ju.0000000000001933

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…Multiple literature reviews reported that these grafts are comparable regarding clinical outcomes; however, the heterogeneity of the series published makes it difficult to conclude ( 1 - 3 , 41 - 43 ). Nevertheless, TachoSil stands out as an operative time saver compared to others ( 3 , 36 , 37 , 44 , 45 ). Due to its ready availability, sutureless application, and hemostatic effect, TachoSil gained popularity in PD surgery.…”

Section: Discussionmentioning

confidence: 85%

“…Early experience with TachoSil patching and plaque incision or excision in patients with an erection hardness score of a mean of 3.4 showed that the score decreased significantly to 2.6 ( 31 ). In subsequent larger and multicenter clinical studies, the TachoSil patch, even with a relatively large size, was associated with nearly ~ 16% de novo erectile dysfunction ( 36 , 37 ). The reported mean longitudinal length of TA defect is 21.9 mm (range, 5–40) for plaque excision ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

“…After patching, the only support to the graft is from the reapproximated buck’s fascia. Early postoperative assessment of erection was not reported; however, longer follow-up results from the same author indicated that 84.3% of patients had unchanged or improved erection ( 36 ). This figure is comparable to or even better than all other graft applications for patients with PD and absent erectile dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals

Seyam,

Mandourah,

Kattan

et al. 2023

Transl Androl Urol

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Background A penile tunica defect may arise during surgery in patients with Peyronie’s disease. Collagen fleece (TachoSil) has recently gained popularity in penile surgery to cover the tunica albuginea (TA) defect associated with clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. We aimed to study the histopathology of the TachoSil graft in an experimental animal model for the regeneration of TA, inflammation, fibrosis, and the underlying cavernous tissue. Methods Six adult male Sprague Dawley rats were used. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1 mm × 10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect. The penile skin covering was then restored. At 2 months, the rat penis was excised and examined with hematoxylin, eosin, and trichrome stains. We conducted a literature review of penile grafts in animals for comparison. Results Rats weighed 369.2 gm (standard deviation: 31.5). At 2 months, all rats showed normal-looking penis with complete healing, no scaring, tethering, or gross inflammatory features. Histopathology of the patch site showed fibrosis, chronic inflammation, and foreign body giant cell reaction. There was no generation of a new TA, or new vascularity. No inflammatory or pathological reaction affected the underlying corpus cavernous tissue. One rat died on the 6 th postoperative day. Postmortem showed massive multiorgan hemorrhage consistent with disseminated intravascular coagulopathy (DIC). Unlike some other reported grafts, there is no TA regeneration. Conclusions TachoSil patching of penile TA defect forms a distinctive barrier against inflammation, protecting the underlying corpus cavernosum. However, no regeneration of the tunica defect is observed at 2 months. DIC is a potential complication of systemic absorption of TachoSil.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals

Seyam,

Mandourah,

Kattan

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

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“…Two studies by Hatzchristodoulou et al . 12 13 reported an average increase in penile length of 0.7 cm and 1.1 cm, respectively, after TachoSil surgery. However, a study by Horstmann et al .…”

Section: Resultsmentioning

confidence: 98%

Grafts in Peyronie’s surgery without the use of prostheses: a systematic review and meta-analysis

Natsos,

Tatanis,

Kontogiannis

et al. 2024

Asian Journal of Andrology

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Peyronie’s disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian–Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.

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Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie’s curvatures

Garaz,

Amend,

Stenzl

et al. 2024

Int Urol Nephrol

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Purpose Collagen fleece grafting (CFG) is the recommended treatment for severe Peyronie’s disease (PD) curvature (> 60°), but its efficacy in mild/moderate curvatures remains uncertain. This study evaluated CFG in patients with mild/moderate curvatures (< 60°) at risk of penile shortening or symptomatic plaque. Methods A retrospective review was conducted on patients who underwent surgical treatment for PD using plaque incision or partial plaque excision and CFG. Clinical parameters and complications were reviewed. Subgroup analysis was performed on patients with curvatures of > 60° and curvatures ≤ 60°. Results 89 patients with a median age of 59 years and a median curvature of 70 (20–90)° were identified. Dorsal curvature was predominant in 66% of cases, followed by lateral (16%), ventral (8%), and complex curvatures (10%). Partial plaque excision was performed in 98% of patients, with an average grafting area of 2.1 cm2; 71% had a singular penile plaque, while 29% presented two or more plaques. The comparison between patients with curvatures ≤ 60° and > 60° revealed no significant differences in mean operation time (86.3 vs. 94.4 min, p = 0.13) or in the incidence of postoperative complications, including glans necrosis, hypoesthesia, ecchymosis, bleeding, hematoma, infection, residual curvature, revision surgery, or pain. Conclusions Early postoperative outcomes and complication rates following plaque incision or partial plaque excision and grafting with CFG were comparable in patients with mild/moderate and severe PD deformities. The technique may be a viable option with a similar risk profile for achieving penile straightening in selected PD cases, particularly when plication is not feasible.

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Suture-Free Sealing of Tunical Defect with Collagen Fleece after Partial Plaque Excision in 319 Consecutive Patients with Peyronie's Disease: The Sealing Technique

Cited by 14 publications

References 19 publications

A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals

A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals

Grafts in Peyronie’s surgery without the use of prostheses: a systematic review and meta-analysis

Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie’s curvatures

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