(138) Smaller Tunical Defect With Pre-graft Plication Technique During Peyronie's Disease Surgery May Reduce Postoperative Erectile Function Loss
Authors: Unal S , Aygun S , Erbay O F , Kutluhan M A , Ener K , Ozayar A , Okulu E , Kayigil O 
Published: May 2023

Abstract

Introduction
Peyronie’s disease (PD) is a progressive and benign acquired connective tissue disease characterized by disordered wound healing and local fibrosis of the tunica albuginea (TA). PD has two phases: acute and chronic. Surgery is the gold standard option for the correction of penile deformity in the PD chronic phase. Methods used in surgical treatment include plication, graft repair, and penile prosthesis implantation. Plaque incision (PIG) or excision (PEG) and graft placement are performed during graft repair. However, this technique can cause postoperative erectile dysfunction (ED) related to the size of the TA defect.

Objective
In our clinic, we use a novel "pre-graft plication technique" to reduce disruption of the integrity of the TA in patients with unidirectional curvature &gt; 60 degrees. In this technique, we place 2 or 3 Essed–Schroder sutures on the convex side of the curvature before incision or excision and grafting on the plaque side. Thus, we pull the curvature angle down before PIG/PEG. We aim to improve post-op erectile function by using smaller grafts and TA incisions (figure 1). Our goal for this study was to compare the results of this technique with the standard PIG/PEG technique.

Methods
All patients who were operated on for PD in our clinic between 2010 and 2021 were screened. Patients aged between 40 and 70 years who underwent grafted PD repair were included in the study. Patients who underwent previous penile surgery or hormonal therapy, had significant preoperative ED (IIEF-5 &lt; 17), or who received diagnoses of malignancy or depression were excluded from the study. We found 45 patients on whom we applied the pre-graft plication technique (group 1) and 32 patients on whom we applied the standard grafting technique who were appropriate for our inclusion and exclusion criteria. Demographic characteristics of the patients, comorbidities, preoperative IIEF-5 scores, stretched penile lengths, plaque sizes detected during surgery, graft sizes and types, postoperative IIEF-5 scores at the 3rd and 12th months, and 3-month postoperative penis lengths were recorded. Penile massage and daily 5 mg tadalafil were recommended as post-op rehabilitation. The results were compared with Student’s T-test.

Results
There were no significant differences between the groups in terms of preoperative IIEF-5 scores, penile lengths, age, or comorbidities. While there was no significant difference between the groups in the plaque sizes detected during the operation, the graft size used was significantly smaller in Group 1 than in Group 2. At follow-up, the IIEF-5 scores of the Group 1 were, on average, 1.97 and 2.36 points higher than Group 2 at 3 and 12 months of follow-up, respectively. This difference was statistically significant. There was no significant difference between the groups in terms of penile length (table-1).

Conclusions
Reducing post-op erectile function loss is possible with pre-graft plication technique. The extra plication suture does not cause a significant reduction in penile length.

Disclosure
No