54 / 86
54
Ces Urol 2016; 20(1): 48–56
ORIGINÁLNÍ PRÁCE
indicated. Intraoperatively, an old haematoma
above the pericard graft covered with pseudo‑
capsule (which suprisingly looked exactly like
a pericard patch, while final histopathology re‑
port confirmed a fibrotic tissue) (Fig. 2A). Un‑
derneath the heamathoma a typical hour glass
deformity was detected. The primary site of the
pericard patch implantation remained intact
(Fig. 2B/B
*
). Finally, we corrected the deformity by
means of a new bovine pericard implant (Fig. 2C),
we do not think, that the primary additional peri‑
card sutures were the cause of the haematoma
formation. On the other hand, neither we can ex‑
clude it, to be quite frank. Nevertheless, 6 months
after the primary surgery the PDS 4.0 sutures
were completely resorbed, so logically one would
expect any kind of haemorrhage during the early
phase of the postoperative follow-up.
Mild glans hypoesthesia was reported by three
patients lasting for 5–9 months and posing no
cause of dissatisfaction. Overall, the median gain
in penile length was 1.3 cm (range: 1.2–2.5 cm),
and the median postoperative IIEF-5 score showed
a significant improvement, increasing from the
preoperative 16.0 (range: 15.0–21.0) to 18.5 (range:
17.0–23.0) 6–9 months postoperatively. At that
time all patients were able to have normal sexual
intercourse, three patients required phosphodies‑
terase type 5 inhibitors to obtain more satisfactory
rigidity. No newly developed erectile dysfunction
appeared in these patients. None of the patients
opted for further surgical correction.
DISCUSSION
The plication/corporoplasty procedures are indica‑
ted in patients with sufficient erectile function with
uniplanar curvatures < 60° without hour-glass/
hinge deformity. These techniques are also suita‑
ble for candidates in whom the predicted loss of
penile length is < 20%. Incision and grafting are
reserved for complex deformities with destabilizing
features. Finally, penile prosthesis insertion is the
treatment of choice in PD patient with ED and non‑
-responders to phosphodiesterase-5inhibitors. (10,
11, 14). Prior to surgery, each patient has to undergo
a comprehensive counseling. All potential goals,
patient’s expectations as well as complications
should be discussed with the patient. A detailed
informed consent is a “sine qua non” before the
procedure.
Bovine pericard allograft is commonly used
material for incision and grafting procedure with
low complication rates (14), which is partially, due
to its optimal mechanical properties (15). Reports,
using Egydio technique showed satisfactory results
achieving almost 90% of successfull corrections
with regard to the short and mid term follow up
(8, 16, 17).
To our knowledge, this is the first report descri‑
bing such a modification. We are fully aware, that
the complete correction can be probably obtained
almost in all cases by means of Egydio technique
solely. However, we suppose that for the cases of
minor persistent residual curvature, our proposed
technique can be a safe alternative and accordingly
we decided to correct the residual deviation using
plication of the pericard. In one case, we made
a failure in the final measurement, which resulted
in additional contralateral placement of the “STAGE”
sutures (Fig. 2). The “STAGE” technique, consists of
super cial tunica albuginea excisions according
to geometric principles. This procedure has been
proven as a safe and valid alternative for the tre‑
atment of congenital ventral, dorsal, dorso-lateral
or ventro-lateral curvature of the penis with regard
to the short and long-term follow up (9, 12).
Our findings showed a low complication rate,
in a rather small cohort of patients, with a rela‑
tively short term follow up. The median gain in
penile length was 1.3 cm in our study, which is
comparable to the previous reports on plication
and grafting procedures (8, 16, 17). After a median
follow up of 14 months all patients reported satis‑
factory erections sufficient for sexual intercourse.
All the partners were satisfied as well. As of this
fact, the logical explanation is, that all men had
intraoperatively relatively small plaques, mostly
located mostly on the dorsal aspect of the penis
(only 2 pts dorsolateral), which corresponds with
the favourable final outcome (17). Some disturbing