Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
Identifieur interne : 007637 ( Ncbi/Merge ); précédent : 007636; suivant : 007638Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach
Auteurs : Kathy Lue ; Justin B. Emtage ; Daniel R. Martinez ; Christopher Yang ; Rafael CarrionSource :
- Sexual Medicine [ 2050-1161 ] ; 2015.
Abstract
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.
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.
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.
The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.
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.
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.
Url:
DOI: 10.1002/sm2.49
PubMed: 26185673
PubMed Central: 4498825
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Martinez</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Yang, Christopher" sort="Yang, Christopher" uniqKey="Yang C" first="Christopher" last="Yang">Christopher Yang</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Carrion, Rafael" sort="Carrion, Rafael" uniqKey="Carrion R" first="Rafael" last="Carrion">Rafael Carrion</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26185673</idno><idno type="pmc">4498825</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498825</idno><idno type="RBID">PMC:4498825</idno><idno type="doi">10.1002/sm2.49</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000208</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000208</idno><idno type="wicri:Area/Pmc/Curation">000208</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000208</idno><idno type="wicri:Area/Pmc/Checkpoint">001273</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001273</idno><idno type="wicri:Area/Ncbi/Merge">007637</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach</title><author><name sortKey="Lue, Kathy" sort="Lue, Kathy" uniqKey="Lue K" first="Kathy" last="Lue">Kathy Lue</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Emtage, Justin B" sort="Emtage, Justin B" uniqKey="Emtage J" first="Justin B" last="Emtage">Justin B. Emtage</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Martinez, Daniel R" sort="Martinez, Daniel R" uniqKey="Martinez D" first="Daniel R" last="Martinez">Daniel R. Martinez</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Yang, Christopher" sort="Yang, Christopher" uniqKey="Yang C" first="Christopher" last="Yang">Christopher Yang</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author><author><name sortKey="Carrion, Rafael" sort="Carrion, Rafael" uniqKey="Carrion R" first="Rafael" last="Carrion">Rafael Carrion</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation></author></analytic><series><title level="j">Sexual Medicine</title><idno type="ISSN">2050-1161</idno><idno type="eISSN">2050-1161</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>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.</p></sec><sec><title>Aims</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Main Outcome Measures</title><p>The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bella, Aj" uniqKey="Bella A">AJ Bella</name></author><author><name sortKey="Perelman, Ma" uniqKey="Perelman M">MA Perelman</name></author><author><name sortKey="Brant, Wo" uniqKey="Brant W">WO Brant</name></author><author><name sortKey="Lue, Tf" uniqKey="Lue T">TF Lue</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ralph, D" uniqKey="Ralph D">D Ralph</name></author><author><name sortKey="Gonzalez Cadavid, N" uniqKey="Gonzalez Cadavid N">N Gonzalez-Cadavid</name></author><author><name sortKey="Mirone, V" uniqKey="Mirone V">V Mirone</name></author><author><name sortKey="Perovic, S" uniqKey="Perovic S">S Perovic</name></author><author><name sortKey="Sohn, M" uniqKey="Sohn M">M Sohn</name></author><author><name sortKey="Usta, M" uniqKey="Usta M">M Usta</name></author><author><name sortKey="Levine, L" uniqKey="Levine L">L Levine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martinez, D" uniqKey="Martinez D">D Martinez</name></author><author><name sortKey="Ercole, Ce" uniqKey="Ercole C">CE Ercole</name></author><author><name sortKey="Hakky, Ts" uniqKey="Hakky T">TS Hakky</name></author><author><name sortKey="Kramer, A" uniqKey="Kramer A">A Kramer</name></author><author><name sortKey="Carrion, R" uniqKey="Carrion R">R Carrion</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levine, La" uniqKey="Levine L">LA Levine</name></author><author><name sortKey="Burnett, Al" uniqKey="Burnett A">AL Burnett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dibenedetti, Db" uniqKey="Dibenedetti D">DB Dibenedetti</name></author><author><name sortKey="Nguyen, D" uniqKey="Nguyen D">D Nguyen</name></author><author><name sortKey="Zografos, L" uniqKey="Zografos L">L Zografos</name></author><author><name sortKey="Ziemiecki, R" uniqKey="Ziemiecki R">R Ziemiecki</name></author><author><name sortKey="Zhou, X" uniqKey="Zhou X">X Zhou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lowsley, Os" uniqKey="Lowsley O">OS Lowsley</name></author><author><name sortKey="Boyce, Wh" uniqKey="Boyce W">WH Boyce</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hall, Wt" uniqKey="Hall W">WT Hall</name></author><author><name sortKey="Turner, Rw" uniqKey="Turner R">RW Turner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fournier, Gr" uniqKey="Fournier G">GR Fournier</name></author><author><name sortKey="Lue, Tf" uniqKey="Lue T">TF Lue</name></author><author><name sortKey="Tanagho, Ea" uniqKey="Tanagho E">EA Tanagho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lue, Tf" uniqKey="Lue T">TF Lue</name></author><author><name sortKey="El Sakka, Ai" uniqKey="El Sakka A">AI El-Sakka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Austoni, E" uniqKey="Austoni E">E Austoni</name></author><author><name sortKey="Altieri, Vm" uniqKey="Altieri V">VM Altieri</name></author><author><name sortKey="Tenaglia, R" uniqKey="Tenaglia R">R Tenaglia</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Sex Med</journal-id><journal-id journal-id-type="iso-abbrev">Sex Med</journal-id><journal-id journal-id-type="publisher-id">sm2</journal-id><journal-title-group><journal-title>Sexual Medicine</journal-title></journal-title-group><issn pub-type="ppub">2050-1161</issn><issn pub-type="epub">2050-1161</issn><publisher><publisher-name>John Wiley & Sons, Ltd</publisher-name><publisher-loc>Chichester, UK</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26185673</article-id><article-id pub-id-type="pmc">4498825</article-id><article-id pub-id-type="doi">10.1002/sm2.49</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lue</surname><given-names>Kathy</given-names></name><degrees>BS</degrees><xref ref-type="aff" rid="au1"></xref></contrib><contrib contrib-type="author"><name><surname>Emtage</surname><given-names>Justin B</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"></xref></contrib><contrib contrib-type="author"><name><surname>Martinez</surname><given-names>Daniel R</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"></xref></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Christopher</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"></xref></contrib><contrib contrib-type="author"><name><surname>Carrion</surname><given-names>Rafael</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><aff id="au1"><institution>Department of Urology, Morsani College of Medicine, University of South Florida</institution><addr-line>Tampa, FL, USA</addr-line></aff></contrib-group><author-notes><corresp id="cor1"><bold>Corresponding Author:</bold> Rafael Carrion, MD, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle STC 6, Tampa, FL 33606, USA. Tel: 813-259-8645; Fax: 813-259-8507; E-mail: <email>rcarrion@health.usf.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>18</day><month>3</month><year>2015</year></pub-date><volume>3</volume><issue>2</issue><fpage>86</fpage><lpage>89</lpage><permissions><copyright-statement>© 2015 The Authors. <italic>Sexual Medicine</italic> published by Wiley Periodicals, Inc. on behalf of International Society for Sexual Medicine.</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>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.</license-p></license></permissions><abstract><sec><title>Introduction</title><p>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.</p></sec><sec><title>Aims</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Main Outcome Measures</title><p>The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusion</title><p>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.</p></sec></abstract><kwd-group><kwd>Peyronie’s Disease</kwd><kwd>Plaque Excision</kwd><kwd>Patch Grafting</kwd><kwd>“Window” Technique</kwd></kwd-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Carrion, Rafael" sort="Carrion, Rafael" uniqKey="Carrion R" first="Rafael" last="Carrion">Rafael Carrion</name><name sortKey="Emtage, Justin B" sort="Emtage, Justin B" uniqKey="Emtage J" first="Justin B" last="Emtage">Justin B. Emtage</name><name sortKey="Lue, Kathy" sort="Lue, Kathy" uniqKey="Lue K" first="Kathy" last="Lue">Kathy Lue</name><name sortKey="Martinez, Daniel R" sort="Martinez, Daniel R" uniqKey="Martinez D" first="Daniel R" last="Martinez">Daniel R. Martinez</name><name sortKey="Yang, Christopher" sort="Yang, Christopher" uniqKey="Yang C" first="Christopher" last="Yang">Christopher Yang</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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