A novel autologous material for the surgical treatment of Peyronie's disease: the outer plate of the prepuce.

Abstract

Background: Peyronie's disease (PD), a connective tissue disease, is characterized by the formation of fibrous lesions or plaques in the tunica albuginea. Many PD patients rely on surgical treatment methods. This study aimed to investigate the feasibility of using the outer plate of the prepuce to repair the defect of the corpus cavernosum after plaque enucleation in patients with PD.

Methods: The defect of the corpus cavernosum in eleven patients with PD [lateral curvature (n=4), dorsal curvature (n=6), and both dorsal and lateral curvature (n=1)] was repaired using the outer plate of the prepuce. The penile lengths of the patients before and after the operation were measured. The International Index of Erectile Function-5 (IIEF-5) questionnaire score was determined and RigiScan (nocturnal penile tumescence and rigidity mode) was performed before and 3 months after the operation. The patient underwent intracavernous injection (ICI) and color Doppler duplex ultrasound (CDDU) examinations before the operation to rule out the presence of vascular erectile dysfunction (ED).

Results: All eleven patients with PD could maintain the physiological penile erection after the operation. In the early stage, only one patient experienced numbness and hypoesthesia, which resolved after 3 months. The recurrence of penile deformity and induration was low. All patients were sexually competent with both patients and their sexual partners reporting improved satisfaction. The penile length of the patient after the operation (9.55±1.34 minutes) was shorter than that before the operation (12.00±1.55 minutes). The IIEF-5 score at month 3 post-operation was 22.73±0.79 points, which was higher than that before the operation (22.09±0.70 points) (P>0.05). RigiScan revealed that the duration of the erectile hardness, which was greater than 60%, at month 3 post-operation (12.76±1.12 minutes) was higher than that before surgery (12.04±1.61 minutes) (P>0.05). The peak systolic velocity and end-diastolic volume before the operation were 42.83±5.27 and 0.13±0.75 cm/s, respectively.

Conclusions: The toughness and ductility of the outer plate of the prepuce are conducive to repairing the corpus cavernosum defect and mitigating the foreign body sensation and rejection reaction in patients with PD.