Plaque Incision and Grafting using bovine pericardium for the treatment of severe ventral curvature in Peyronie’s disease

L. Karapanos

Peyronie’s Disease, Grafting, Ventral Curvature, Bovine Pericardium

Introduction:

Ventral penile curvature caused by Peyronie’s disease (PD) is relatively rare and usually corrected by shortening procedures, including excisional or plication surgeries. Penile length-preserving surgery, which involves plaque incision/excision and grafting, is reserved for severe curvatures and patients with good erectile function. However, the limited length of the penile urethra restricts the ability to lengthen the anterior corporal wall by several centimeters. In addition, length-preserving PD surgery is usually performed through a subcoronal incision followed by circumcision and degloving. Some patients, however, have a strong wish to retain their prepuce.

Case presentation:

We present the case of a 58-year-old male patient with a 90-degree ventral penile curvature due to PD. Due to the patient's strong desire to preserve his prepuce, access was gained through a penoscrotal longitudinal incision. The urethra was dissected from the corpora cavernosa up to the prebulbar region to gain additional length.

The points of maximum deviation were incised transversely, and the defects were covered with bovine pericardium grafts (Peri-Guard®). With the penis stretched, the urethra was fixed distally to the corpora cavernosa under slight upward traction. The surgical time was 122 minutes. A standardized penile rehabilitation protocol was used for six weeks, including daily low-dose tadalafil, manual penile stretching, and a penile vacuum device.

Outcome:

At three months the penis was straightened entirely, with no preputial lymphedema or compromise of erectile function. The stretched penile length remained unchanged. The patient was delighted with the functional and aesthetic outcome of the surgery.

Conclusion:

Plaque incision and grafting using bovine pericardium through a longitudinal penoscrotal incision is a viable option for the treatment of severe ventral curvature in PD patients, with a strong wish to retain their prepuce.

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