Peyronie’s Disease (PD) is a connective tissue disorder of the penis affecting the tunica albuginea. This disorder can lead to penile deformity and local pain. No one knows what causes PD; however, it is thought that PD could be caused by repetitive microvascular trauma, causing inflammation, excessive collagen deposition, and fibrinogenesis on the tunica albuginea. Risk factors such as dyslipidemias, smoking, hypertension, and alcoholism may have an effect.
There are two phases in PD: acute and chronic. The acute stage is characterized by inflammation that causes pain and the beginnings of penile deformity. The chronic stage is when penile curvature stabilizes, pain stops, and plaque appears on the corpora cavernosa. Patients can undergo various surgical techniques once they enter the second stage of PD and have stable curves for 3-6 months.
One such surgical procedure is plaque incision or excision and grafting. During this procedure, an incision or partial excision is performed of the penile plaque. This leads to a ‘gap’ or deficit in the tunica, over which a surgical graft is placed. The best type of graft needs to be traction resistant, easy to manipulate and suture, readily available, flexible, cost-effective, and associated with minimal morbidity. No graft material studied to date has met all these criteria. The goal of the current study was to perform a descriptive analysis regarding the use of a bioabsorbable graft during PD surgical treatment and report its functional results.
Between 2018 and 2021, a single-center, retrospective cohort study was conducted on 14 patients being treated for PD and who had a Gore Bio-A bioabsorbable graft put in. This graft is made of 67% polyglycolic acid and 33% trimethylene carbonate, which will eventually be absorbed by the body. The average age of the patients was 59.5 (+/- 7.2) with a median curvature of 60 degrees. 35.7% reported erectile dysfunction (ED) (even with PDE5i). Of the 14 patients, 35.7% had uniplanar curvature, 50% had biplanar/complex deformities, and 14.2% had curvatures with a ventral component. The primary goal of treatment was curvature correction (absence of residual curvature greater than 15 degrees). Secondary goals were postoperative ED, surgical complications, and penile sensory change.
After surgery, 3 of the 14 patients still had a curvature greater than 15 degrees; however, 11 of the 14 patients (78.5%) achieved curvature correction. One of 14 patients had decreased sensation in the head of the penis, while 9 of 14 had ED which did not respond to pills like Viagra postoperatively. Four of 14 patients had minor surgical complications such as penile pain and swelling. There were no major surgical complications.
Overall, the authors of this study concluded that the degree of curvature correction and penile sensitivity were similar to other studies in the literature. However, higher rates of refractory ED were seen in this study compared to other publications.
Resources:
Zandoná, P.C.E., Teixeira, N.P., Oliveira, H.E., Garcia, J.H.S. (2022). The use of a polyglycolic acid polymer graft in Peyronie’s disease – preliminary outcomes. Archivio Italiano Urologia e Andrologia, 94(1), 87-90. DOI: 10.4081/aiua.2022.1.87