Peyronie's Disease-Incision and Dorsal Vein Grafting Combined with Contralateral Plication in Straightening the Penis

Abstract

Objectives: To evaluate the effectiveness of incisions of Peyronie's plaque and vein grafting combined with contralateral plication to straightening the penis. Patients and methods: Twenty-four patients with Peyronie's disease were treated surgically with a vein patch grafting technique to correct penile curvature. Median penile deviation was 70° (range 60-90°), in 1 patient curvature was 30° and all were unable to have normal sexual intercourse. The deep dorsal vein was excised and opened longitudinally. Transverse relaxing incisions about 1-2 cm long were made on the plaques at the point of maximal curvature, then, two other lateral incisions were made on both ends at 3 and 9 o'clock. The endothelial side of the harvested vein was placed in contact with the cavernous tissue to cover the defect created. Application of the contralateral surface of the tunica albuginea was performed in 21 cases to straighten the penis. Results: After a median follow-up of 24 months, 19 patients were able to perform sexual intercourse, 3 patients who required intracavernous injection to maintain erection presented pre-operative adverse factors affecting erectile function. One patient returned to baseline pre-operative curvature. Twelve patients reported penile shortening, although only 5 patients were concerned about it. None of the patients permanently lost sensation in the glans of the penis. Palpable knots on the site of plication were reported in 5 patients. Conclusions: Plaque incision and placement of a deep dorsal vein patch graft, combined with contralateral corporeal plication, is a relatively simple, safe and effective alternative to correct angulations greater than 60°.