(101) ERECTILE FUNCTION PRESERVATION AFTER PLAQUE INCISION AND GRAFTING ASSISTED BY IGRAFTER: LONG-TERM RESULTS
Authors: Miranda A 
Published: December 2024

Abstract

Introduction
Peyronie’s disease in patients with normal sexual function and with significant penile curvature exceeding 60o is usually managed through plaque incision and grafting (PIG), particularly in cases with hourglass deformities and a shortened penile length. However, traditional techniques often result in several postoperative complications, including erectile dysfunction (ED), residual curvature, and geometric abnormalities. These methods also require the use of large grafting areas and are limited to correcting only uniplanar curvatures. The iGrafter APP, a new computerized solution designed to assist surgeons in performing PIG has the potential to enhance surgical outcomes. It reduces the graft area, corrects multiplanar curvatures and hourglass deformities, and preserves penile geometry.

Objective
This study aims to present the long-term outcomes of a series of cases involving patients who underwent penile curvature correction through PIG, assisted by the iGrafter APP.

Methods
From January 2012 to July 2021, 16 patients with PD but without ED, with a mean age of 50 years (33 to 68 years), were enrolled in this study. These patients completed the International Index of Erectile Function-5 questionnaire (IIEF5) both before and after undergoing PIG to correct penile deformities, utilizing the iGrafter APP [Fig. 1 and 2]. During the surgery, measurements of penile length, curvature degree, and the presence of hourglass deformity were recorded. At the conclusion of the procedure, the penis was reevaluated to confirm whether the deformity had been completely corrected. Additionally, intraoperative and postoperative complications were recorded. Postoperative patient satisfaction was also assessed.

Results
The 16 patients who underwent surgical correction included 7 with uniplanar curvature, showing a mean deviation of 68o (45o to 120o), and 9 with multiplanar curvature, with a mean primary curvature of 61o (45o to 87o) and a mean secondary curvature of 27o (7o to 50o). Additionally, 9 of the patients presented with an hourglass deformity associated with their curvature. All patients achieved complete correction of their penile deformities with a mean graft area of 15.2 cm2. After a mean follow-up of 111 months (33 to 147 months), the postoperative IIEF-5 scores showed no significant decline from baseline (p = 0.446), indicating preserved erectile function. The mean penile length remained nearly unchanged, measuring 13.5 cm before surgery and 13.15 cm afterward (p = 0.979). Overall, 81% of patients were satisfied with the surgical outcomes and would choose to perform the surgery again.

Conclusions
The long-term result of PIG technique, with the assistance of the iGrafter, utilizes a reduced graft area to correct penile deformities. It effectively addresses complex cases involving multiplanar curvatures, with or without hourglass deformities, preserving penile geometry and length. The preservation of penile geometry, which improves penile biomechanics, combined with a significant reduction in graft area and less scar tissue, could explain the maintained erectile function, resulting in high patient satisfaction.

Disclosure
No.