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Editorial Comment: Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie's disease—a matched pair analysis

International Journal of Impotence Research volume 31, page 301 (2019)Cite this article

Treatment for advanced Peyronie's disease continues to evolve. Despite the advent of collagenase Clostridium histolyticum (CCH; Xiaflex®, Endo Pharmaceuticals Inc., Malvern, PA, USA), and advanced penile traction devices, grafting techniques are recommended in men with > 60° curvature with preserved erectile function who wish to maintain penile length [1]. This article elegantly compares outcomes of an established popular grafting material small intestinal submucosa (SIS) with a novel graft material collagen fleece (CF) [https://doi.org/10.1038/s41443-018-0071-1]. Both achieve excellent outcomes, however, CF was somewhat superior given decreased operative time (due to the fact that the graft need not be meticulously sewn over the defect), complete penile straightening rates and no long-term follow up contracture/recurrence. However, mobilization of the neurovascular bundle and violation of the corpora always necessitates patient counseling about possible paresthesias and worsening erectile function regardless of technique [2].

In my own experience, I have switched to CF for severe curvature correction both with and without concomitant penile implant. In cases without simultaneous implant, not having to sew the graft in allows one to liberally incise the plaque for optimal straightening regardless of the resultant corporal defect. Several times earlier in my career I have meticulously sewn in a graft only to find unsatisfactory straightening and the need for plication sutures. With simultaneous penile implant, CF obviates device puncture and decreases operative time.

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References

  1. Hatzichristodoulou G, Osmonov D, Kübler H, Hellstrom WJG, Yafi FA. Contemporary review of grafting techniques for the surgical treatment of Peyronie’s disease. Sex Med Rev. 2017;5:544–52.

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  2. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, American Urological Association Education and Research, Inc.,. et al. Peyronie’s Disease: AUA Guideline. J Urol. 2015;194:745–53. https://doi.org/10.1016/j.juro.2015.05.098. Epub 2015 Jun 9.

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  1. Mayo Clinic, Rochester, MN, USA

    Tobias S Köhler

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  1. Tobias S Köhler
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Correspondence to Tobias S Köhler.

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Köhler, T.S. Editorial Comment: Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie's disease—a matched pair analysis. Int J Impot Res 31, 301 (2019). https://doi.org/10.1038/s41443-018-0080-0

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