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Efficacy of H-shaped incision with bovine pericardial graft in Peyronie’s disease: a 1-year follow-up using penile Doppler ultrasonography

International Journal of Impotence Research volume 33, pages 541–547 (2021)Cite this article

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A Correction to this article was published on 07 August 2020

A Correction to this article was published on 31 July 2020

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Abstract

We present our experience with the use of an H-shaped incision and a bovine pericardial graft in patients with Peyronie’s disease (PD). In this retrospective study, 21 male patients with PD who underwent an H-shaped incision and received a bovine pericardial graft were included and followed for at least 1 year. The degree of penile curvature in all subjects was >60°. Patients had no erectile dysfunction prior to surgery. Outcomes assessed were resistive index (RI) in penile Doppler ultrasonography, improvements in curvature, erection hardness score, and postoperative patient satisfaction. The median age of the 21 patients was 58 (55, 63) years and the median duration of PD was 7 (6, 12) months. As the efficacy variable, there was no statistically significant change in the RI of the corpus cavernosum at 1 year post-surgery. The degree of penile curvature in the erectile state was remarkably decreased from 70 (60, 90) degree to 5 (5, 15) degree (P < 0.001). There was no significant change in the erection hardness score before and after surgery. Patient satisfaction evaluated via a Likert-type scale at 1 year after surgery was 4 (4, 5). In multiple linear regression analysis, patient satisfaction was correlated with the intraoperative defect size created by H-shaped incision (P = 0.009) and inversely related with the residual curvature (P < 0.001). The results from the subjective symptom score and the objective penile Doppler ultrasonography suggest that the H-shaped incision and the subsequent graft with the bovine pericardium is safe and effective in patients with PD. It is necessary to minimize the remnant curvature during graft surgery, because postoperative patient satisfaction was closely correlated with postoperative residual curvature.

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Fig. 1: Graft surgery using bovine pericardium.
Fig. 2: Doppler ultrasound image of the cavernosal artery and velocity spectrum.
Fig. 3: Factors associated with postoperative patient satisfaction.

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References

  1. 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.

    Article  Google Scholar 

  2. Ostrowski KA, Gannon JR, Walsh TJ. A review of the epidemiology and treatment of Peyronie’s disease. Res Rep. Urol. 2016;8:61–70.

    CAS  PubMed  PubMed Central  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.

    Article  Google Scholar 

  4. Tunuguntla HS. Management of Peyronie’s disease—a review. World J Urol. 2001;19:244–50.

    Article  CAS  Google Scholar 

  5. 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.

    Article  CAS  Google Scholar 

  6. Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A, et al. EAU guidelines on penile curvature. Eur Urol. 2012;62:543–52.

    Article  Google Scholar 

  7. Silva-Garreton A, Santillan D, Chavez D, Gioielli A, Rey-Valzacchi G, Layus O, et al. Satisfaction of patients with Peyronie’s disease after plaque surgery and bovine pericardium graft. Actas Urol Espanolas. 2017;41:103–8.

    CAS  Google Scholar 

  8. Egydio PH, Lucon AM, Arap S. Treatment of Peyronie’s disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft. Urology. 2002;59:570–4.

    Article  Google Scholar 

  9. Otero JR, Gomez BG, Polo JM, Mateo CP, Barreras SG, Cruz EG, et al. Use of a lyophilized bovine pericardium graft to repair tunical defect in patients with Peyronie’s disease: experience in a clinical setting. Asian J Androl. 2017;19:316–20.

    Article  Google Scholar 

  10. Goldstein I, Mulhall JP, Bushmakin AG, Cappelleri JC, Hvidsten K, Symonds T. The erection hardness score and its relationship to successful sexual intercourse. J Sex Med. 2008;5:2374–80.

    Article  Google Scholar 

  11. Taylor FL, Levine LA. Surgical correction of Peyronie’s disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up. J Sex Med. 2008;5:2221–8. discussion 2229-30

    Article  Google Scholar 

  12. Golijanin D, Singer E, Davis R, Bhatt S, Seftel A, Dogra V. Doppler evaluation of erectile dysfunction—part 2. Int J Impot Res. 2007;19:43–48.

    Article  CAS  Google Scholar 

  13. Golijanin D, Singer E, Davis R, Bhatt S, Seftel A, Dogra V. Doppler evaluation of erectile dysfunction—part 1. Int J Impot Res. 2007;19:37–42.

    Article  CAS  Google Scholar 

  14. Lowsley OS, Boyce WH. Further experiences with an operation for the cure of peyronie’s disease. J Urol. 1950;63:888–902.

    Article  CAS  Google Scholar 

  15. Kadioglu A, Sanli O, Akman T, Ersay A, Guven S, Mammadov F. Graft materials in Peyronie’s disease surgery: a comprehensive review. J Sex Med. 2007;4:581–95.

    Article  Google Scholar 

  16. Bassiouny HS, Levine LA. Penile duplex sonography in the diagnosis of venogenic impotence. J Vasc Surg. 1991;13:75–82. discussion 82-73

    Article  CAS  Google Scholar 

  17. Fernandes MAV, de Souza L, Cartafina LP. Ultrasound evaluation of the penis. Radiol Bras. 2018;51:257–61.

    Article  Google Scholar 

  18. Jung DC, Park SY, Lee JY. Penile Doppler ultrasonography revisited. Ultrasonography. 2018;37:16–24.

    Article  Google Scholar 

  19. Gholami SS, Gonzalez-Cadavid NF, Lin CS, Rajfer J, Lue TF. Peyronie’s disease: a review. J Urol. 2003;169:1234–41.

    Article  Google Scholar 

  20. Paez A, Mejias J, Vallejo J, Romero I, De Castro M, Gimeno F. Long-term patient satisfaction after surgical correction of penile curvature via tunical plication. Int Braz J Urol. 2007;33:502–7. discussion 507-9

    Article  Google Scholar 

  21. Hatzichristodoulou G. Partial plaque excision and grafting with collagen fleece in Peyronie disease. J Sex Med. 2016;13:277–81.

    Article  Google Scholar 

  22. 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.

    Article  CAS  Google Scholar 

  23. Butaney M, Thirumavalavan N, Hockenberry MS, Kirby EW, Pastuszak AW, Lipshultz LI. Variability in penile duplex ultrasound international practice patterns, technique, and interpretation: an anonymous survey of ISSM members. Int J Impot Res. 2018;30:237–42.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jin Bong Choi

  2. Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong Sup Lee

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  1. Jin Bong Choi
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Correspondence to Dong Sup Lee.

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Choi, J.B., Lee, D.S. Efficacy of H-shaped incision with bovine pericardial graft in Peyronie’s disease: a 1-year follow-up using penile Doppler ultrasonography. Int J Impot Res 33, 541–547 (2021). https://doi.org/10.1038/s41443-020-0312-y

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