Peyronie's disease : endocavernous plaque excision without substitutuve graft : critical 5 years experience

Introduction Despite the open and actual debate about the ideal graft to use after plaque excision in Peyronie’s disease, the Polish colleague Darewicz published his surgical experience of endocavernous plaque excision avoiding the use of any substitutive graft. Attracted by the extreme simplification in this new technique, we decided to verify such a surgical approach. Materials and methods The operation can be performed with any kind of anesthesia. We usually prefer local anesthesia with Bupivacaine 5% 20 ml at the penis base. After coronarie incision and cutaneous-dartoic degloving we put in evidence urethral- cavernous axis. The albuginea is cut till erectile tissue which is moved by blunt, few millimeters at the side of the plaque and for all its length, or at the opposite side in case of lateral bending. Then separation of the hardened lesion from overlying albuginea is performed with scissors or scalpel; this cleavage plane is clearly identified just during surgery, otherwise the procedure is converted in the traditional plaque excision and substitutive graft. Once the plaque is removed the cavous incision is sutured and the correct straightening is verified. The operation concludes with penile reassembly and adherent medication. In 5 years we selected 18 cases of stabilized disease and preserved erection but geometrically disturbed for the severe deformity. Results We obtained in all cases substantial straightening, even if in 2 cases we added a complementary minimally invasive surgery in form of plication, and 2 cases were converted in graft technique. At beginning we isolated dorsal neurovascular bundle, in a second phase, discovering the easy dissection of the sinechial plan separating the albuginea from the lesion, this was not anymore necessary. Even without the use of substitutive graft it is palpable - for at least 3 months - an increased consistency in the dorsal side. Conclusions Case studies and current controls allow us to say that the impression is quite good: learning curve is quick and the surgical technique is unquestionably shortened and simplified, without isolation of the dorsal neurovascular bundle, without the necessity of autologous tissue or heterologous matrices to be inserted, allowing a more comfortable post-operative course and a more rapid and easier functional recovery. Peyronie’s disease surgery represents for all surgeons a hard path, our primary goal is to make it easier and more gratifying in the results.