UroToday- Several surgical procedures to correct penile curvature associated with Peyronie's disease have been described. These include tunica albuginea plication, and plaque excision and grafting with temporalis fascia, tunica vaginalis, saphenous vein or nonautologous materials such as silicone, Gore-Tex and Dacron. One such nonautologous graft that has shown promise is porcine SIS (small intestine submucosa), a xenogenic membrane that is harvested from porcine jejunum. It is mechanically stripped of its tunica mucosa, serosa and tunica muscularis, leaving a submucosa matrix that is rich in type 1 collagen (90%) and growth factors that aid the regenerative process.

Recently, Tom Lue's group out of San Francisco reported on the outcomes and complications of their series of Peyronie's patients treated with graft excision and SIS grafting. The report is published in the February 2007 issue of the Journal of Urology.

In the series, 19 patients with severe penile curvature (greater than 60 degrees) compromising sexual function were treated with SIS grafts. Mean patient age was 54 years and the interval from diagnosis to surgery was 2 to 44 months (mean 21 months). Average follow-up was 15 months and tunical defect size ranged from 1.0 x 0.5 cm to 4 x 6 cm. Most men (95%) had dorsal curvature, while 5 (26%) had concurrent hourglass deformity.

An analysis of the outcomes showed that men reported less pain with intercourse after the surgery, but there was no difference in the Sexual Health Inventory for Men (SHIM) scores after surgery. Preoperatively 12 men (63%) reported some degree of erectile dysfunction (six patients used oral phosphodiesterase inhibitors prior to surgery), while 10 (53%) reported post-operative erectile dysfunction. Seven of the 19 patients (37%) had recurrent penile curvature (greater than 10 degrees) and 5 (26%) had recurrent Peyronie's disease plaques. The complication rate was 37%, including hematoma at the graft site in 5 cases (26%), graft infection in 1 (5%), and Peyronie's disease recurrence requiring plication in 1 (5%).

The authors caution the readers that while the SIS graft is easy to use and readily available, the 37% complication rate exceeds those previously published for large series of saphenous vein graft repairs.

Breyer BN, Brant WO, Garcia MM, Bella AJ, Lue TF
J Urol. 2007 Feb; 177(2):589-91

Reviewed by UroToday Contributing Editor Michael J. Metro, MD

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