The dorsal lamina of the rectus sheath: a suitable grafting material for the penile tunica albuginea in Peyronie's disease?

Abstract

OBJECTIVE To estimate the morphological suitability of human connective tissue structures from different regions as graft material in Peyronie's disease, and to present preliminary results from 12 patients with grafting of corporal bodies using autologous rectus sheath. PATIENTS AND METHODS In five male cadavers the penile tunica albuginea was compared with the dorsal lamina of the rectus sheath, the palmar aponeurosis, the iliotibial tract and the Achilles tendon by using histological sections stained with haematoxylin and eosin, Crossmon's trichrome stain and resorcin‐fuchsin. Surgical results and complication rates were investigated in 12 patients with Peyronie's disease after grafting the corporal bodies with autologous rectus sheath to correct their penile curvature. RESULTS On histology, the penile tunica albuginea showed a three‐dimensional meshwork of collagenous and elastic fibres. The dorsal lamina of the rectus sheath had a remarkably similar fibre structure. The other tissues had a different histology, with long collagenous fibres in parallel orientation and elastic fibres restricted to the loose connective tissue around blood vessels and nerves. Clinically, the penile deviation was successfully corrected in 10 patients; there were two residual deviations (15° and 35°). There were minor complications after surgery in six patients, not requiring surgery. CONCLUSIONS The dorsal lamina of the rectus sheath has similar morphological characteristics to the tunica albuginea, and therefore represents an ideal autologous graft; the first clinical results are promising.

Peyronie’s surgery: Graft choices and outcomes

“…Craatz et al [36] investigated the use of the dorsal lamina of the rectus sheath as a suitable graft material for PD. The fi rst part of this study was a histologic examination of rectus fascia, palmar aponeurosis, the iliotibial tract, and the Achilles tendon.…”

Addressing residual penile deformity in the Peyronie’s disease patient during penile implant surgery

“…This has the most similar structure to tunica albuginea and can be easily harvested without a second incision if penile prosthesis insertion is carried out through an infrapubic approach. Furthermore, due to its low metabolic rate, fascia inherently is resistant to ischemia and less prone to contracture [30,31]. These characteristics make autologous rectus fascia an ideal graft.…”

Treatment of Peyronie’s Disease: 2012 Update

“…Autologous grafts were initially used for PD surgery in the 1950s [94] with different types of tissues, such as temporal fascia [95], buccal mucosa [96][97][98], deep dorsal vein [99], saphenous vein [100][101][102], preputium [103], dermis [71,[104][105][106], tunica albuginea [107][108][109], tunica vaginalis [110], fascia lata [111], and rectus sheath [112]. Some surgeons use saphenous vein due to its simplicity and reliability of harvesting, large surface area, good compliance, and lesser amount of intracavernosal fibrosis [1, 74•, 113].…”