Experience with Extra-Tunical Grafting and Tunica Albuginea Plication for Correction of Indentation Deformity in Men with Peyronie's Disease - Beyond the Abstract
Tunica albuginea plication (TAP) alone often cannot address indentation and hourglass deformity, and tunica albuginea (TA) disruption with either plaque incision with grafting or plaque excision with grafting is associated with a higher rate of erectile dysfunction and hypoesthesia. Thus, the development of a newer technique, extra-tunical grafting (ETG), is a relatively new surgical option to treat corporal indentation and hourglass deformities when not associated with axial instability.
In this article, the primary objective was to determine cosmetic satisfaction with deformity correction between patients undergoing different ETG locations and different types of ETG grafts. Secondary objectives included graft palpability and visibility in flaccid and erect state, and recurrence of indentation deformity. In our study, we found a high overall surgical satisfaction rate (85.7%), as well as satisfaction with correction of penile indentation (94.3%) using graft tissue when placed under or over Buck fascia. We found no statistical difference in grafting location under or over Buck fascia and satisfaction with penile appearance (82.8% and 91.7%, respectively, p = 0.47). Additionally, patients experienced minimal penile hypoesthesia (2.9%).
At a median follow-up of almost two years, persistent correction of penile deformity was seen in 88.6% of patients, and while some report visibility of the graft (48.6%) and palpability (74.3%) in the flaccid state, this tends to disappear in the erect state, and no patients reported bother with the graft.
While much remains unknown, this series begins to address many unanswered concerns, including the feasibility of graft location under and over Buck fascia, long-term outcomes with respect to recurrence, thickening/contraction of the grafts, recurrent indentation, and palpability/visibility of the grafts over time. Despite a small population size, at almost 2 years our series represents the longest follow-up and largest cohort to complete follow-up reported with a very low side effect profile. Though long-term data remains limited, we believe ETG presents a less invasive surgical option than traditional approaches to correct volume loss deformity and improve cosmesis when not associated with axial instability. For those patients with instability or hinge effect, we do not recommend ETG, rather partial plaque excision, and grafting when the patient has excellent quality preoperative erections or placement of an inflatable penile prosthesis when rigidity is less reliable.
Written by: Daniel Roadman, MD, Jose Quesada-Olarte MD, William Langbo, MD, Spencer Mossack, MD, and Laurence Levine, MD
Rush University Medical Center Department of Urology, Chicago, IL
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