Peyronie’s Disease and ED: Plaque incision and Tachosil®
D. Osmonov, F. Prell, K-P Juenemann, *G. Hatzichristodoulou
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel. Germany
*Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Germany
This video demonstrates a method of surgical treatment for Peyronie’s disease. We show the use of Tachosil® graft with and without penile prosthesis implantation.
Tachosil® graft without penile prosthesis implantation:
The video shows a step-by-step grafting procedure with detailed visualization of the surgical technique: After mobilization of the neurovascular bundle an artificial erection is induced. The point of maximal curvature is identified. A deep incision of the tunica albuginea is done. This must be performed carefully to preserve the underlying cavernous tissue. Hence a fragment of the tunica albuginea is removed and the penis is straightened to judge the final result. A wet collagen fleece is then carefully attached to the tunical defect. The edges of the fleece must overlap the defect over a distance of at least 5 mm to achieve an adequate sealing effect.
Tachosil® graft in combination with penile prosthesis implantation:
After performance of the complete implantation procedure, the penis is degloved through the penoscrotal access. Buck`s fascia is incised to evaluate the dorsal neurovascular bundle like above. The penile prosthesis is inflated to max., and the point of maximal stricture was identified. Using low energy (20 accordingly to the valley lap setting), the tunica albuginea is incised towards the inflated cylinder. A wet Tachosil fleece is then attached to the defect in the same way and by same principles. Buck´s fascia is adapted using a continuous suture.
Conclusion:
The use of collagen fleece as a graft is an alternative option with attractive perspectives due its timesaving and easy application. This type of graft can be used in other similar clinical situations where comparable grafting methods are used otherwise. Collagen fleece can be used both for curvature treatment in patients with intact erectile function and in patients with severe ED and curvature.