Small intestinal submucosa for patch grafting after plaque incision in the treatment of Peyronie's disease

ABSTRACT

OBJECTIVE: Report the results using porcine small intestinal submucosa (SIS) as a graft material in the surgical management of Peyronie's disease (PD). MATERIALS AND METHODS: We performed a retrospective chart review of men with PD who underwent surgical correction of the curvature by plaque “H” incision and patch grafting with 4-ply SIS (Cook, Bloomington, IN) by a single surgeon at our institution. Degree and direction of curvature, sexual function, and co-morbidities were assessed pre- and postoperatively. RESULTS: Thirteen patients were identified. Mean age was 57 ± 8, range 42-70 years. Median follow-up was 14 months, range 3-89 months. At presentation, all reported penile curvature. Also reported were difficulty with vaginal penetration (determined by question number 2 of the sexual encounter profile questionnaire - SEP2), palpable plaque, hourglass deformity, difficulty with firmness, and difficulty with sustaining erection (determined by SEP3) in77 percent, 69 percent, 77 percent, 62 percent, and 46 percent of patients, respectively. Mean and median degrees of curvature of the primary deformity were 71 and 67.5 degrees, respectively. Three patients had secondary curves of less than 30 degrees in a different direction. Mean and median plaque size were 3.5 and 2.7 cm², respectively. Seven patients had one graft and six patients had two grafts placed with a mean size of 15 ± 0 cm². CONCLUSIONS: For the patient with PD, SIS grafting can achieve a functionally straight erection with durable results yet with relatively high rates of erectile dysfunction. SIS is a viable graft material for use in the surgical treatment of PD.