V11-03: Correcting Peyronie’s Curvature with Plaque Incision and Grafting Using Temporalis Fascia
Plaque incision and grafting is an ideal technique to correct severe acquired penile curvature. Though there is no consensus on the best graft material, many options are available. The graft should allow for preservation of erectile function, resist infection, be watertight, have minimal contraction, and feel natural. Using an IRB-approved database, we present our contemporary experience of 93 patients with Peyronie’s curvature treated with plaque incision and grafting using a temporalis fascia free graft.
With the patient in supine position, a circumcising incision is made and the penis is degloved to the base of the penis. A tourniquet is placed and an artificial erection created with normal saline. The area of maximal curvature is identified and the tourniquet is released. The neurovascular bundle is identified and sharply dissected within Buck’s fascia and elevated from the tunica. Concurrently, temporalis fascia is harvested from above the left ear by a second surgical team. A template is created based on the size and shape of the anticipated defect. After graft preparation, the tourniquet is replaced and a full-thickness tunical incision is made at the point of maximal curvature. A modified Y, H, or transverse incision is used depending on the degree and angle of curvature. With the tunical defect exposed, the graft is sutured into the tunica albuginea using 5-0 suture. The tourniquet is released as soon as permissible and the repair is inspected to ensure that it is watertight. The skin edges of the circumcision are approximated using absorbable suture. On post-operative day 5, the patient is instructed to gently massage the graft. 4 weeks after surgery the patient is permitted to resume sexual activity and is advised to use a vacuum-erection device daily to restore elasticity to the penis.
No high-grade intraoperative complications were observed. After a mean follow-up of 7.91 months (0.87 – 46.93 months), correction of penile curvature was achieved in 87 (93.5%) patients. 6 patients complained of residual curvature and underwent additional plication surgery. 5 patients underwent subsequent IPP placement. No donor site morbidity was observed including infection, scarring, swelling, or lymphedema.
Free grafting using temporalis fascia offers achieves excellent long-term functional and cosmetic outcomes with minimal donor-site morbidity.