Peyronie’s Disease Reconstruction with Saphenous Vein Graft

Authors: Widi Atmoko, Dimas T Prasetyo, Giulio Garaffa

Key words: Peyronie’s disease, saphenous vein graft

Reconstructive surgery for Peyronie’s disease has been a challenge for urologists and plastic surgeons alike. Despite the many surgical management options, grafting procedures offer favourable results for patients with severe curvature and significant penile-length loss. Based on its source, there are three types of graft materials: autologous graft, allogeneic graft, and synthetic graft. In Indonesia, the use of allogeneic graft has not been regulated and synthetic grafts are not available yet. Among autologous graft sources, saphenous vein is still one of the favoured choices for large defect after incision of tunica albuginea. In this video, we outlines the use of saphenous vein graft for penis reconstruction in Peyronie’s disease. Following circumglanular incision at the penile shaft, the penis is degloved down to the base. Neurovascular bundle including the deep dorsal vein is carefully preserved. The apex of the curvature is marked and a double-Y incision is made. Tunical defect is then measured to determine the length of the saphenous vein needed to cover the defect. We use the femoral part of the right saphenous vein with the length adjusted to the dimension of tunical defect. The harvested vein is detubularised, divided into 2 parts with equal measurements, and sutured continuously to form a patch.

The patch is then placed onto the tunical defect and sutured with 5-0 polydioxanone (PDS), continuously. Artificial erection is performed to confirm whether there is still any curvature. The Buck’s fascia is sutured using 4-0 vicryl, continuously. Superficial fascia, penile skin, and inguinal wounds are closed using interrupted suture with 4-0 vicryl.

The male urethral mini-sling, in combination with placement of an inflatable penile prosthesis, is a surgical approach to treat patients experiencing post-radical prostatectomy erectile dysfunction with concurrent climacturia and/or mild stress urinary incontinence. The technique in this video represents a modification to the “mini-jupette,” as described by Robert Andrianne, MD, in 2005. Initial results are excellent, with >90% of men reporting complete resolution of climacturia and 85% reporting improvement in stress incontinence.

Acknowledgements: none

Disclosures: The authors have nothing to disclose.

References