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Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach

INTRODUCTION: Peyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising i...

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Autores principales: Lue, Kathy, Emtage, Justin B, Martinez, Daniel R, Yang, Christopher, Carrion, Rafael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498825/
https://www.ncbi.nlm.nih.gov/pubmed/26185673
http://dx.doi.org/10.1002/sm2.49
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author Lue, Kathy
Emtage, Justin B
Martinez, Daniel R
Yang, Christopher
Carrion, Rafael
author_facet Lue, Kathy
Emtage, Justin B
Martinez, Daniel R
Yang, Christopher
Carrion, Rafael
author_sort Lue, Kathy
collection PubMed
description INTRODUCTION: Peyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. AIMS: The aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. METHODS: A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting. MAIN OUTCOME MEASURES: The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair. RESULTS: The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature. CONCLUSION: A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.
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spelling pubmed-44988252015-07-16 Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach Lue, Kathy Emtage, Justin B Martinez, Daniel R Yang, Christopher Carrion, Rafael Sex Med Case Report INTRODUCTION: Peyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. AIMS: The aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. METHODS: A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting. MAIN OUTCOME MEASURES: The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair. RESULTS: The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature. CONCLUSION: A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation. John Wiley & Sons, Ltd 2015-06 2015-03-18 /pmc/articles/PMC4498825/ /pubmed/26185673 http://dx.doi.org/10.1002/sm2.49 Text en © 2015 The Authors. Sexual Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Sexual Medicine. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Case Report
Lue, Kathy
Emtage, Justin B
Martinez, Daniel R
Yang, Christopher
Carrion, Rafael
Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title_full Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title_fullStr Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title_full_unstemmed Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title_short Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
title_sort excision and patch grafting of a lateral peyronie’s plaque—utilizing a longitudinal “window” approach
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498825/
https://www.ncbi.nlm.nih.gov/pubmed/26185673
http://dx.doi.org/10.1002/sm2.49
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