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Ces Urol 2016; 20(1): 48–56
ORIGINÁLNÍ PRÁCE
INTRODUCTION
Tunical lengthening procedures with grafting are
indicated in patients with severe penile length loss,
curvatures greater than 60°, prominent hourglass
deformities and complex penile deformities with
the high risk of penile shortening when correc‑
ted by the means of plication procedure only (1).
Generally penile angulation is responsible for the
sexual dysfunction, pain during the intercourse as
well as severe psychological traumata. Medication
treatments are also unpredictable and in cases
of complex deformities rather non-effective (2).
Moreover, the effects of the minimally invasive
procedures such as lasers and local infiltrations
directly into the plaque are equivocal with regard
to the long term effectivity (3, 4). Although recent
reports on Clostridium collagenase application
seem promising, there is a strong need to define
the eligible candidates, because of the persistent
lack of general understanding of the complexity
of Peyronie’s disease origin (5, 6, 7). That is why,
surgical correction is often required in order to ob‑
tain a functionally and cosmetically normal penis.
Nonetheless, the “victims of the Peyronie’s disease”
(PD) usually tend to regain their self-esteem and
a new stronger status of masculinity after succe‑
ssful procedure. For more complex cases as men‑
tioned above, by using a grafting technique, the
shortening of the penis can be avoided. Herein, we
report on the small cohort of patients with biplanar
deformity caused by PD using Egydio technique
(8,9), modified by additional suture placement di‑
rectly on the patch, in order to correct the residual
curvature.
MATERIALS AND METHODS
Preoperative assessment included personal/me‑
dical history, physical examination, assessment of
erectile function with the administration of the
International Index of Erectile Function 5 (IIEF-5)
questionnaire, “selfies” (photographs of the penis
in erect state – anterio-posterior and lateral view, in
order to document the degree and direction of the
deformity) and Doppler ultrasound of the penis.
In 3 cases, the self-images were not conclusive,
therefore we performed and artificial erection in
ambulatory setting before planning for the final
procedure. Stretched penile length was recorded
pre- and postoperatively. Surgical complications,
cosmetic outcome, sexual function, patient satis‑
faction and postoperative erectile function were
assessed postoperatively at 3 months, 6–9 months
and 1 year thereafter (“phone call questions inter‑
view”). In all patients with an IIEF score of less than
15 and a dynamic echo colour Doppler ultrasound
scan to evaluate the degree of penile deformity
and the peak systolic velocity in the cavernosal
arteries was indicated. A peak systolic velocity (PSV)
of less than 35 cm s
-1
was the exclusion criterion.
The patients with such values were counselled
against undergoing the operation and offered
penile prosthesis implantation
. The final indication
for surgery was based upon the proposed guide‑
lines on penile curvature (10, 11). Patients from the
study cohort had a stable disease for at least 9–12
months, prior to the surgical procedure. A detailed
preoperative information concerning procedure
expectations, complications and treatment course
was shared with the patients. An informed con‑
sent was obtained finally from each candidate.
Additionally, patients were offered the foreskin‑
-sparing approach. All candidates who decided
not to undergo circumcision, where fully informed
about the possible complications.
The surgical procedure included plaque incisi‑
on with partial excision and grafting according to
the geometrical principles described by Egydio et
al (8, 9). As a graft material we used bovine peri‑
card graft in all 9 cases (Supple Peri-Guard 6x8 cm,
Synovis Surgical Innovations, W. St. Paul, MN, USA).
If some degree of deformity persisted after the in‑
duction of a artificial erection perioperatively (after
graft placement), we decided to place additional
sutures directly on the graft with regard to the
geometrical principles.
Patients were discharged from the hospital
on the postoperative day 1 and recommended
to refrain masturbation or sexual intercourse for
6 weeks. Erection was assessed postoperatively