Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

The use of collagen fleece (TachoSil) as grafting material in the surgical treatment of Peyronie’s disease. A comprehensive narrative review

International Journal of Impotence Research volume 34, pages 260–268 (2022)Cite this article

Subjects

Abstract

Grafting for the treatment of Peyronie’s disease (PD) can be performed with autologous grafts, allografts, xenografts and synthetic grafts, with all available materials presenting their own characteristics. Still, there is a current arising interest in the use of collagen fleece (TachoSil) as grafting material. We generated an extensive literature review, aiming to assess the use of TachoSil in the treatment of PD. TachoSil is currently indicated in men with PD and preserved erectile function for defect closure after partial plaque excision or incision. In addition, it is indicated for residual curvature correction during penile prosthesis implantation (PPI) in patients with PD and severe erectile dysfunction. Our literature search identified 12 studies evaluating the role of TachoSil for PD surgical treatment. We presented the surgical procedure of TachoSil grafting for the treatment of complex penile curvatures with or without simultaneous PPI and summarized the available evidence on the matter. Identified studies suggest that TachoSil is considered highly effective, reliable and safe in patients with PD. Moreover, it displays favorable properties compared to other grafting materials. It should be stressed that, despite some limitations of available data, TachoSil presents key strengths, which include easy application, decreased operative times, no risk of damaging the implant during PPI, preservation or increase in penile length, fewer cases of penile hypoesthesia, low risk of other adverse events, additional hemostatic effects and low cost. Still, randomized trials comparing TachoSil with different grafting materials are necessary to establish its efficacy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: The sealing technique: TachoSil grafting in Peyronie’s disease without concomitant penile prosthesis implantation.
Fig. 2: The PICS Technique: TachoSil grafting in Peyronie’s disease during penile prosthesis implantation.

Similar content being viewed by others

References

  1. Devine CJ, Somers KD, Jordan SG, Schlossberg SM. Proposal: trauma as the cause of the Peyronie’s lesion. J Urol. 1997;157:285–90. https://doi.org/10.1016/s0022-5347(01)65361-8.

    Article  PubMed  Google Scholar 

  2. Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, et al. Evidence-based management guidelines on Peyronie’s disease. J Sex Med. 2016;13:905–23. https://doi.org/10.1016/j.jsxm.2016.04.062.

    Article  PubMed  Google Scholar 

  3. Stuntz M, Perlaky A, des Vignes F, Kyriakides T, Glass D. The prevalence of Peyronie’s disease in the United States: a population-based study. PLoS ONE. 2016;11:e0150157. https://doi.org/10.1371/journal.pone.0150157.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Tal R, Hall MS, Alex B, Choi J, Mulhall JP. Peyronie’s disease in teenagers. J Sex Med. 2012;9:302–8. https://doi.org/10.1111/j.1743-6109.2011.02502.x.

    Article  PubMed  Google Scholar 

  5. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015;194:745–53. https://doi.org/10.1016/j.juro.2015.05.098.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kadioglu A, Sanli O, Akman T, Cakan M, Erol B, Mamadov F. Surgical treatment of Peyronie’s disease: a single center experience with 145 patients. Eur Urol. 2008;53:432–40. https://doi.org/10.1016/j.eururo.2007.04.045.

    Article  PubMed  Google Scholar 

  7. Hudak SJ, Morey AF, Adibi M, Bagrodia A. Favorable patient reported outcomes after penile plication for wide array of Peyronie disease abnormalities. J Urol. 2013;189:1019–24. https://doi.org/10.1016/j.juro.2012.09.085.

    Article  PubMed  Google Scholar 

  8. Hatzichristodoulou G. Grafting techniques for Peyronie’s disease. Transl Androl Urol. 2016;5:334–41. https://doi.org/10.21037/tau.2016.03.16.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Levine LA, Dimitriou RJ. A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie’s disease. Int J Impot Res. 2000;12:147–51. https://doi.org/10.1038/sj.ijir.3900515.

    Article  CAS  PubMed  Google Scholar 

  10. Verze P, Sokolakis I, Manfredi C, Collà Ruvolo C, Hatzichristodoulou G, Romero-Otero J.Penile prosthesis implant in the management of Peyronies’ disease: a systematic review of the literature.Minerva Urol Nefrol. 2020; https://doi.org/10.23736/S0393-2249.20.03890-4.

    Article  PubMed  Google Scholar 

  11. 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. https://doi.org/10.1016/j.sxmr.2017.01.006.

    Article  Google Scholar 

  12. Garcia-Gomez B, Ralph D, Levine L, Moncada-Iribarren I, Djinovic R, Albersen M, et al. Grafts for Peyronie’s disease: a comprehensive review. Andrology. 2018;6:117–26. https://doi.org/10.1111/andr.12421.

    Article  CAS  PubMed  Google Scholar 

  13. Hatzichristodoulou G. 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. 2019;31:304. https://doi.org/10.1038/s41443-018-0082-y.

    Article  PubMed  Google Scholar 

  14. Hatzichristodoulou G. Evolution of the surgical sealing patch TachoSil® in Peyronie’s disease reconstructive surgery: technique and contemporary literature review. World J Urol. 2020;38:315–21. https://doi.org/10.1007/s00345-019-02792-w.

    Article  PubMed  Google Scholar 

  15. INN-TachoSil; Annex I: summary of product characteristis. https://www.ema.europa.eu/en/documents/product-information/tachosil-epar-product-information_en.pdf. Accessed 25 Nov 2020.

  16. Colombo GL, Bettoni D, Di Matteo S, Grumi C, Molon C, Spinelli D, et al. Economic and outcomes consequences of TachoSil®: a systematic review. Vasc Health Risk Manag. 2014;10:569–75. https://doi.org/10.2147/VHRM.S63199.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Simonato A, Varca V, Esposito M, Venzano F, Carmignani G. The use of a surgical patch in the prevention of lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer: a randomized prospective pilot study. J Urol. 2009;182:2285–90. https://doi.org/10.1016/j.juro.2009.07.033.

    Article  PubMed  Google Scholar 

  18. Siemer S, Lahme S, Altziebler S, Machtens S, Strohmaier W, Wechsel H-W, et al. Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney tumour resection: a randomised prospective study. Eur Urol. 2007;52:1156–63. https://doi.org/10.1016/j.eururo.2007.04.027.

    Article  CAS  PubMed  Google Scholar 

  19. Lahme S, Götz T, Bichler K-H. Collagen fleece for defect coverage following plaque excision in patients with Peyronie’s disease. Eur Urol. 2002;41:401–5. https://doi.org/10.1016/s0302-2838(02)00024-6.

    Article  CAS  PubMed  Google Scholar 

  20. Horstmann M, Kwol M, Amend B, Hennenlotter J, Stenzl A. A self-reported long-term follow-up of patients operated with either shortening techniques or a TachoSil grafting procedure. Asian J Androl. 2011;13:326–31. https://doi.org/10.1038/aja.2010.157.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hatzichristodoulou G, Gschwend JE, Lahme S. Surgical therapy of Peyronie’s disease by partial plaque excision and grafting with collagen fleece: feasibility study of a new technique. Int J Impot Res. 2013;25:183–7. https://doi.org/10.1038/ijir.2013.7.

    Article  CAS  PubMed  Google Scholar 

  22. Hatzichristodoulou G, Fiechtner S, Gschwend J, Kübler H, Lahme S. Suture-free sealing of tunical defect with collagen fleece after partial plaque excision in Peyronie’s disease: long-term outcomes of the sealing technique. Eur Urol Suppl. 2017;16:e2152. https://doi.org/10.1016/S1569-9056(17)31304-0.

    Article  Google Scholar 

  23. Salonia A, Bettochi C, Carvalho J, Corona G, Jones TH, Kadioğlu A, et al. “EAU guidelines on sexual and reproductive health 2020,”. In: European Association of Urology Guidelines. 2020 Edition. Arnhem, The Netherlands: European Association of Urology Guidelines Office. https://uroweb.org/guideline/sexual-and-reproductive-health/.

  24. Fabiani A, Fioretti F, Filosa A, Servi L, Mammana G. Patch bulging after plaque incision and grafting procedure for Peyronie’s disease. Surgical repair with a collagen fleece. Arch Ital Urol Androl. 2015;87:173–4. https://doi.org/10.4081/aiua.2015.2.173.

    Article  CAS  PubMed  Google Scholar 

  25. Levine LA, Burnett AL. Standard operating procedures for Peyronie’s disease. J Sex Med. 2013;10:230–44. https://doi.org/10.1111/j.1743-6109.2012.03003.x.

    Article  PubMed  Google Scholar 

  26. Hatzichristodoulou G. Partial plaque excision and grafting with collagen fleece in Peyronie disease. J Sex Med. 2016;13:277–81. https://doi.org/10.1016/j.jsxm.2015.12.011.

    Article  PubMed  Google Scholar 

  27. Hatzichristodoulou G. Surgical therapy of Peyronie’s disease by partial plaque excision and sealing of tunical defect with collagen fleece: the sealing technique. Video J Prosth Urol. 2016;2:076.

    Google Scholar 

  28. Hatzichristodoulou G, Tsambarlis P, Kübler H, Levine LA. Peyronie’s graft surgery-tips and tricks from the masters in andrologic surgery. Transl Androl Urol. 2017;6:645–56. https://doi.org/10.21037/tau.2017.07.17.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hatzichristodoulou G. Introducing the ventral sealing technique using collagen fleece for surgical therapy of patients with ventral Peyronie’s curvature: initial experience. Int J Impot Res. 2018;30:306–11. https://doi.org/10.1038/s41443-018-0044-4.

    Article  CAS  PubMed  Google Scholar 

  30. Yafi FA, Diao L, DeLay KJ, DeYoung L, Talib R, Alzweri L, et al. Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie’s disease. Urology. 2018;120:138–42. https://doi.org/10.1016/j.urology.2018.06.049.

    Article  PubMed  Google Scholar 

  31. Rosenhammer B, Sayedahmed K, Fritsche HM, Burger M, Kübler H, Hatzichristodoulou G. 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. 2019;31:256–62. https://doi.org/10.1038/s41443-018-0071-1.

    Article  CAS  PubMed  Google Scholar 

  32. de Sallmard G, Morel-Journel N, Sbizzera M, Hanquiez P, Ruffion A, Terrier J-E. Incision de plaque et greffe de Tachosil chez les patients atteints d’une maladie de Lapeyronie. Prog Urol. 2020;30:119–25. https://doi.org/10.1016/j.purol.2019.11.011.

    Article  PubMed  Google Scholar 

  33. Wilson SK, Delk JR. A new treatment for Peyronie’s disease: modeling the penis over an inflatable penile prosthesis. J Urol. 1994;152:1121–23. https://doi.org/10.1016/s0022-5347(17)32519-3.

    Article  CAS  PubMed  Google Scholar 

  34. Whelan P, Levine LA. Additional procedures performed at time of penile prosthesis implantation: a review of current literature. Int J Impot Res. 2020;32:89–98. https://doi.org/10.1038/s41443-019-0118-y.

    Article  PubMed  Google Scholar 

  35. Hatzichristodoulou G. A novel approach for residual curvature correction during inflatable penile prosthesis implantation in patients with Peyronie’s disease: the PICS technique. Video J Prosth Urol 2018;2:139.

    Google Scholar 

  36. Rolle L, Falcone M, Ceruti C, Timpano M, Sedigh O, Ralph DJ, et al. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the “sliding” technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117:814–20. https://doi.org/10.1111/bju.13371.

    Article  CAS  PubMed  Google Scholar 

  37. Hatzichristodoulou G. The PICS technique: a novel approach for residual curvature correction during penile prosthesis implantation in patients with severe Peyronie’s disease using the collagen fleece TachoSil. J Sex Med. 2018;15:416–21. https://doi.org/10.1016/j.jsxm.2017.12.012.

    Article  PubMed  Google Scholar 

  38. Falcone M, Preto M, Ceruti C, Timpano M, Garaffa G, Sedigh O, et al. A comparative study between 2 different grafts used as patches after plaque incision and inflatable penile prosthesis implantation for end-stage Peyronie’s disease. J Sex Med. 2018;15:848–52. https://doi.org/10.1016/j.jsxm.2018.04.632.

    Article  PubMed  Google Scholar 

  39. Farrell MR, Abdelsayed GA, Ziegelmann MJ, Levine LA. A comparison of hemostatic patches versus pericardium allograft for the treatment of complex peyronie’s disease with penile prosthesis and plaque incision. Urology. 2019;129:113–8. https://doi.org/10.1016/j.urology.2019.03.008.

    Article  PubMed  Google Scholar 

  40. Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, Turo J, Martínez-Ballesteros C, Carballido J, et al. Surgical technique for complex cases of Peyronie’s disease with implantation of penile prosthesis, multiple corporeal incisions, and grafting with collagen fleece. J Sex Med. 2019;16:323–32. https://doi.org/10.1016/j.jsxm.2018.11.014.

    Article  PubMed  Google Scholar 

  41. Hatzichristodoulou G, Yang DY, Ring JD, Hebert KJ, Ziegelman MJ, Köhler TS. Multicenter experience using collagen fleece for plaque incision with grafting to correct residual curvature at the time of inflatable penile prosthesis placement in patients with Peyronie’s disease. J Sex Med. 2020;17:1168–74. https://doi.org/10.1016/j.jsxm.2020.02.019.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany

    Ioannis Sokolakis, Nikolaos Pyrgidis & Georgios Hatzichristodoulou

Authors
  1. Ioannis Sokolakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolaos Pyrgidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgios Hatzichristodoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in the drafting, writing, and editing of the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Georgios Hatzichristodoulou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sokolakis, I., Pyrgidis, N. & Hatzichristodoulou, G. The use of collagen fleece (TachoSil) as grafting material in the surgical treatment of Peyronie’s disease. A comprehensive narrative review. Int J Impot Res 34, 260–268 (2022). https://doi.org/10.1038/s41443-020-00401-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00401-8

This article is cited by

Search

Advanced search

Quick links