VJPU 2016; 2: 076
Georgios Hatzichristodoulou
Keywords: Peyronie’s disease; surgery; partial plaque excision; collagen fleece; sealing technique
Introduction: This video demonstrates the novel surgical Sealing Technique for Peyronie’s repair in advanced cases when penile deviation exceeds 60°.
Case presentation: The patient presented in this video shows a 70° dorsal deviation. Sexual intercourse was not possible due to the extent of deviation. Thus, surgical correction was indicated.
Protocol: After penile degloving and lateral mobilization of the neurovascular bundle, an artificial erection is performed to check the point of maximum curvature and the deformity. At the point of maximum curvature on the dorsal aspect of the penis, a partial plaque excision is performed in an ellipsoid style. The tunical defect is then extended laterally on both sides. The resulting defect is sealed with a self-adhesive collagen fleece (TachoSil, Baxter, Deerfield, IL, USA). After 3 minutes a water-tight sealing/closure of the tunical defect is provided. No additional sutures are required. In the next step, the neurovascular bundle is reapproximated and Buck’s fascia closed by a running absorbable suture.
Outcome: Artificial erection at the end of the procedure shows complete straightening of the penis, without any residual deviation.
Discussion: Sealing of the tunical defect following partial plaque excision in the surgical management of Peyronie’s disease is a successful procedure. In comparison to grafting techniques, the Sealing Technique is associated with saving in operative time. This is achieved by the use of a self-adhesive collagen fleece which does not have to be sewed into the tunical defect.