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Tunical Incision Techniques for Peyronie’s Disease

  • Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)
  • Published:
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Abstract

Purpose of Review

Tunical plaque incisions are common techniques utilized during grafting procedures for Peyronie’s disease. The aim of this review was to examine the different tunical incisional and excisional techniques, as well as outcomes and complications of recent graft procedures utilizing these strategies.

Recent Findings

Studies on tunical incision, partial excision, and grafting techniques vary with regards to their surgical outcomes, post-operative erectile dysfunction rates, and other complications. Overall, significant penile straightening has been reported in recent studies of incision and grafting for Peyronie’s disease.

Summary

Prospective trials comparing the different tunical incisional techniques are needed to better plan surgical interventions for Peyronie’s disease.

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References

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  1. Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou X. A population-based study of Peyronie’s disease: prevalence and treatment patterns in the United States. Adv Urol. 2011;2011:282503.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Stuntz M, Perlaky A, des Vignes F, Kyriakides T, Glass D. The prevalence of Peyronie’s disease in the United States: a population-based study. PLoS One. 2016;11(2):e0150157.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, et al. Evidence-based management guidelines on Peyronie’s disease. J Sex Med. 2016;13(6):905–23.

    Article  PubMed  Google Scholar 

  4. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s Disease: AUA Guideline. J Urol. 2015;194(3):745–53.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hatzichristodoulou G, Meisner C, Gschwend JE, Stenzl A, Lahme S. Extracorporeal shock wave therapy in Peyronie’s disease: results of a placebo-controlled, prospective, randomized, single-blind study. J Sex Med. 2013;10(11):2815–21.

    Article  PubMed  Google Scholar 

  6. Bilgutay AN, Pastuszak AW. Peyronie’s disease: a review of etiology, diagnosis, and management. Curr Sex Health Rep. 2015;7(2):117–31.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yang KK, Bennett N. The history of collagenase Clostridium histolyticum. Sex Med Rev. 2015;3(4):289–97.

    Article  PubMed  Google Scholar 

  8. Larsen SM, Levine LA. Review of non-surgical treatment options for Peyronie’s disease. Int J Impot Res. 2012;24(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  9. Ralph D, Gonzalez-Cadavid N, Mirone V, Perovic S, Sohn M, Usta M, et al. The management of Peyronie’s disease: evidence-based 2010 guidelines. J Sex Med. 2010;7(7):2359–74.

    Article  PubMed  Google Scholar 

  10. Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A, et al. EAU guidelines on penile curvature. Eur Urol. 2012;62(3):543–52.

    Article  PubMed  Google Scholar 

  11. •• Hatzichristodoulou G, Osmonov D, Kubler H, Hellstrom WJ, Yafi FA. Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie’s Disease. Sex Med Rev. 2017. This study reviews current methods of surgical management for PD.

  12. • Lipshultz LI, Goldstein I, Seftel AD, Kaufman GJ, Smith TM, Tursi JP, et al. Clinical efficacy of collagenase clostridium histolyticum in the treatment of Peyronie’s disease by subgroup: results from two large, double-blind, randomized, placebo-controlled, phase III studies. BJU Int. 2015;116(4):650–6. This prospective study evaluates the efficacy of collagenase clostridium histolyticum in the treatment of PD.

    Article  CAS  PubMed  Google Scholar 

  13. • Gelbard M, Goldstein I, Hellstrom WJ, CG MM, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190(1):199–207. This prospective study evaluates the efficacy of collagenase clostridium histolyticum in the treatment of PD.

    Article  CAS  PubMed  Google Scholar 

  14. • Levine LA, Dimitriou RJ. A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease. Int J Impot Res. 2000;12(u):147–51. This study reviews the algorithm for prosthesis placement in men with PD and ED.

    Article  CAS  PubMed  Google Scholar 

  15. El-Sakka AI, Rashwan HM, Lue TF. Venous patch graft for Peyronie’s disease. Part II: outcome analysis. J Urol. 1998;160(6 Pt 1):2050–3.

    CAS  PubMed  Google Scholar 

  16. • Egydio PH, Lucon AM, Arap S. A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles. BJU Int. 2004;94(7):1147–57. This study evaluates a novel technique using geometry for tunical incisions.

    Article  PubMed  Google Scholar 

  17. Brant WO, Bella AJ, Garcia MM, Tantiwongse K, Lue TF. Surgical atlas. Correction of Peyronie’s disease: plaque incision and grafting. BJU Int. 2006;97(6):1353–60.

    Article  PubMed  Google Scholar 

  18. Flores S, Choi J, Alex B, Mulhall JP. Erectile dysfunction after plaque incision and grafting: short-term assessment of incidence and predictors. J Sex Med. 2011;8(7):2031–7.

    Article  PubMed  Google Scholar 

  19. • Yafi FA, Pinsky MR, Sangkum P, Hellstrom WJ, et al. Andrology. 2015;3(4):650–60. This study reviews different therapies available for PD.

    Article  CAS  PubMed  Google Scholar 

  20. Cantoro U, Polito M, Catanzariti F, Montesi L, Lacetera V, Muzzonigro G. Penile plication for Peyronie’s disease: our results with mean follow-up of 103 months on 89 patients. Int J Impot Res. 2014;26(4):156–9.

    Article  CAS  PubMed  Google Scholar 

  21. Novick AC, Streem SB, Pontes JE, Stewart BH. Stewart’s operative urology. 2nd ed. Baltimore: Williams & Wilkins; 1989.

    Google Scholar 

  22. McVary KT. Contemporary treatment of erectile dysfunction : a clinical guide. New York: Humana; 2011. xii, 287 p. p.

  23. Segal RL, Burnett AL. Surgical Management for Peyronie’s disease. World J Mens Health. 2013;31(1):1–11.

    Article  PubMed  PubMed Central  Google Scholar 

  24. • Kozacioglu Z, Degirmenci T, Gunlusoy B, Kara C, Arslan M, Ceylan Y, et al. Effect of tunical defect size after Peyronie’s plaque excision on postoperative erectile function: do centimeters matter? Urology. 2012;80(5):1051–5. This study compares different plaque excision size and outcomes.

    Article  PubMed  Google Scholar 

  25. • Hatzichristodoulou G, Gschwend JE, Lahme S. Surgical therapy of Peyronie’s disease by partial plaque excision and grafting with collagen fleece: feasibility study of a new technique. Int J Impot Res. 2013;25(5):183–7. This study evaluates partial plaque excision with grafting of collage fleece.

    Article  CAS  PubMed  Google Scholar 

  26. • Salem EA, Elkady EH, Sakr A, Maarouf AM, Bendary L, Khalil S, et al. Lingual mucosal graft in treatment of Peyronie disease. Urology. 2014;84(6):1374–7. This study evaluates outcomes of partial plaque excision with grafting using lingual mucosa.

    Article  PubMed  Google Scholar 

  27. Da Ros CT, Graziottin TM, Ribeiro E, Averbeck MA. Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft. Int Braz J Urol. 2012;38(2):242–7. discussion 8–9. This study evaluates outcomes of tunical incision with autologous grafting using albugineal crural graft.

    Article  PubMed  Google Scholar 

  28. Zucchi A, Silvani M, Pastore AL, Fioretti F, Fabiani A, Villirillo T, et al. Corporoplasty using buccal mucosa graft in Peyronie disease: is it a first choice? Urology. 2015;85(3):679–83. This study evaluates outcomes of tunical incision and grafting using buccal mucosa.

    Article  PubMed  Google Scholar 

  29. Cosentino M, Kanashiro A, Vives A, Sanchez J, Peraza MF, Moreno D, et al. Surgical treatment of Peyronie’s disease with small intestinal submucosa graft patch. Int J Impot Res. 2016;28(3):106–9. This study evaluates outcomes of tunical incisions and grafting using small intestinal submucosa.

    Article  CAS  PubMed  Google Scholar 

  30. Fabiani A, Servi L, Fioretti F, Maurelli V, Tombolini F, Filosa A, et al. Buccal mucosa is a promising graft in Peyronie's disease surgery. Our experience and a brief literature review on autologous grafting materials. Arch Ital Urol Androl. 2016;88(2):115–21. This study evaluates oucomes of tunical incisions and grafting using buccal mucosa.

    Article  PubMed  Google Scholar 

  31. Wimpissinger F, Parnham A, Gutjahr G, Maksys S, Baierlein M, Stackl W. 10 Years’ plaque incision and vein grafting for Peyronie's disease: does time matter? J Sex Med. 2016;13(1):120–8. This study evaluates outcomes of tunical incisions and vein grafting.

    Article  PubMed  Google Scholar 

  32. Sayedahmed K, Rosenhammer B, Spachmann PJ, Burger M, Aragona M, Kaftan BT, et al. Bicentric prospective evaluation of corporoplasty with porcine small intestinal submucosa (SIS) in patients with severe Peyronie’s disease. World J Urol. 2016. This study evaluates outcomes of tunical incisions and small intestinal mucosa grafting in severe PD.

  33. Miranda AF, Sampaio FJ. Practical computerized solution for incision and grafting in Peyronie’s disease. Sex Med. 2016;4(2):e73–82. This study evaluates outcomes using novel software for planning tunical incisions in PD.

    PubMed  Google Scholar 

  34. Baldini A, Morel-Journel N, Paparel P, Ruffion A, Terrier JE. Patient-reported long-term sexual outcomes following plication surgery for penile curvature: a retrospective 58-patient study. Prog Urol. 2017;27(1):10–6.

    Article  CAS  PubMed  Google Scholar 

  35. Vicini P, Di Nicola S, Antonini G, De Berardinis E, Gentile V, De Marco F. Geometrical modified nesbit corporoplasty to correct different types of penile curvature: description of the surgical procedure based on geometrical principles and long-term results. Int J Impot Res. 2016;28(6):209–15.

    Article  CAS  PubMed  Google Scholar 

  36. Levine LA, Larsen SM. Surgery for Peyronie’s disease. Asian J Androl. 2013;15(1):27–34.

    Article  PubMed  Google Scholar 

  37. •• Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie’s disease. J Urol. 1997;158(6):2149–52. This study reviews the surgical options for treatment of PD.

    Article  CAS  PubMed  Google Scholar 

  38. • Yafi FA, Sangkum P, IR MC, Hellstrom WJ. Strategies for penile prosthesis placement in Peyronie’s disease and corporal fibrosis. Curr Urol Rep. 2015;16(4):21. This study reviews techniques for penile prosthesis placement in the setting of PD.

    Article  PubMed  Google Scholar 

  39. Levine LA, Burnett AL. Standard operating procedures for Peyronie’s disease. J Sex Med. 2013;10(1):230–44.

    Article  PubMed  Google Scholar 

  40. Zaid UB, Alwaal A, Zhang X, Lue TF. Surgical management of Peyronie’s disease. Curr Urol Rep. 2014;15(10):446.

    Article  PubMed  Google Scholar 

  41. Carson CC, Levine LA. Outcomes of surgical treatment of Peyronie’s disease. BJU Int. 2014;113(5):704–13.

    Article  PubMed  Google Scholar 

  42. Wang R, Howard GE, Hoang A, Yuan JH, Lin HC, Dai YT. Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection. Asian J Androl. 2009;11(4):411–5.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tran H, Goldfarb R, Ackerman A, Valenzuela RJ. Penile Lengthening, Girth, and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev. 2017;

  44. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, et al. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012;9(9):2389–95.

    Article  PubMed  Google Scholar 

  45. • Egydio PH, Kuehhas FE, Valenzuela RJ. Modified sliding technique (MoST) for penile lengthening with insertion of inflatable penile prosthesis. J Sex Med. 2015;12(5):1100–4. This study evaluates a modified sliding technique for penile lengthening during IPP placement.

    Article  PubMed  Google Scholar 

  46. • Egydio PH, Kuehhas FE. Penile lengthening and widening without grafting according to a modified ‘sliding’ technique. BJU Int. 2015;116(6):965–72. This study evaluates a modified sliding technique for penile lengthening during IPP placement without use of grafting.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Faysal A. Yafi.

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Garen Abedi and Faysal A. Yafi each declare no potential conflict of interest.

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This article contains no studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Male and Female Surgical Interventions

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Abedi, G., Yafi, F.A. Tunical Incision Techniques for Peyronie’s Disease. Curr Sex Health Rep 9, 170–175 (2017). https://doi.org/10.1007/s11930-017-0110-9

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