V11-01: Suture-free sealing of tunical defect with collagen fleece after partial plaque excision in Peyronie’s disease: Long-term outcomes of the Sealing technique
Grafting techniques are preferred for the surgical treatment in advanced Peyronie&[prime]s disease (PD) to avoid penile shortening. In this video we present the novel suture-free Sealing technique for Peyronie&[prime]s repair using a self-adhesive collagen fleece as an alternative to grafting. We moreover report on long-term surgical outcomes of this novel technique.
Patients with stable PD who were unable to perform sexual intercourse were included. After partial plaque excision, the tunical defect was sealed by a self-adhesive collagen fleece (TachoSil®, Baxter, IL, USA) that does not require suture fixation. Results of correction were documented intraoperatively by artificial erection and penile length measurement. Pre- and postoperative evaluation consisted of IIEF-5 score, penile length, sonography and artificial erection.
From December 2004 to June 2015, n=319 patients underwent surgery. Mean patient age was 58.0 years (33-74). 78.1% of patients had dorsal deviation and 21.9% dorsolateral deviation. Mean deviation angle was 73.5° (45-110°) dorsal and 23.2° (15-40°) lateral. The Sealing technique was performed in all the cases. Mean operative time was 79.8 minutes (50-130min). Totally straightness of the penis was achieved in 299/319 (93.7%) patients. After a mean long-term follow-up of 47.2 months (12-100mon), erectile function improved in 24.5%, remained unchanged in 59.8%, and worsened in 15.7% of patients. Mean penile length before and after surgery was 13.8 cm (6-21cm) and 14.9 cm (8-22cm), respectively. 300/319 patients (94.0%) had normal glans sensation. Patient satisfaction rate was as high as 87.8%.
The Sealing technique for Peyronie&[prime]s repair is a safe procedure and provides reliable long-term results. It is a suture-free technique, as the collagen fleece does not need to be sewn into the tunical defect following partial plaque excision. A preparation and sewing of a graft can be omitted. Thus, operative times are reduced. The collagen fleece also provides an additional haemostatic effect. The Sealing technique moreover represents a cost-effective technique for PD reconstructive surgery.