Howell, S, Khalafalla, K, Wang, R

Peyronie’s, Grafting, Urethral Tethering, Plication

Peyronie's disease, a condition characterized by penile curvature, affects approximately 9% of men. Surgical interventions including plication of the tunica albuginea, incision or excision of the plaque with grafting procedures, penile prosthesis implantation, or various combinations of these, are often employed to address this bothersome condition. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. In this video we demonstrate a case of a gentleman with Peyronie’s disease suffering from severe, 90-degree ventral curvature and penile shortening due to urethral tethering who was therefore recommended excision and grafting. However, even after excision and grafting with Tutoplast pericardial allograft, due to urethral tethering the patient still had residual ventral curvature. We therefore performed a dorsal tunica albuginea plication using sixteen dot technique which allowed for additional curvature correction while maintaining penile length. Contralateral (dorsal vs ventral) tunical plication combined with grafting procedures is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. This video shows that excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results.

1. Cormio L, Mancini V, Massenio P, d'Altilia N, Selvaggio O, Di Fino G, Selvaggi G, Carrieri G. Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease. J Sex Med, 2019; 7(1):48-53.