Reconstruction of Severe Dorsal Penile Curvature in Peyronie’s Disease via Tunical Excision and Bovine Pericardial Grafting

O. Canguven, A.Al Saeedi, G. Sadiq, K. Al Kubaisi

allograft, corporal reconstruction, curvature correction, fascia lata graft, Peyronie’s disease

Introduction:

Peyronie’s disease is a debilitating condition characterized by the formation of fibrotic plaques within the tunica albuginea of the penis, leading to abnormal penile curvature, deformity, and often significant compromise of sexual function and psychological well-being. While conservative management may be sufficient in mild cases, surgical intervention becomes necessary in patients with severe or complex deformities, especially when curvature exceeds 60 degrees or impairs penetrative intercourse. Among various surgical approaches, tunical excision with grafting has emerged as a standard option for plaque removal and restoration of penile straightness. Bovine pericardial grafts are frequently used due to their favorable characteristics, including strength, elasticity, low antigenicity, and ease of intraoperative manipulation.

Objective:

This video aims to provide a detailed, step-by-step overview of the surgical technique of tunical excision and grafting using bovine pericardial patches in the correction of severe dorsal penile curvature associated with Peyronie’s disease. The focus is on technical precision, complication avoidance, neurovascular preservation, and optimization of functional outcomes.

Methods:

The procedure begins with circumferential penile degloving to expose the tunica albuginea, followed by meticulous dissection and lateral mobilization of the dorsal neurovascular bundle to allow safe access to the underlying plaque. The fibrotic segment of tunica is then excised, creating a defect which is reconstructed using a custom-shaped bovine pericardial graft. The graft is carefully sutured into place with a non-absorbable monofilament, ensuring anatomic alignment, appropriate sizing, and a tension-free closure to promote optimal graft integration and healing. Intraoperative artificial erection testing confirms the correction of curvature and absence of penile instability or buckling.

Results:

In the presented case, the surgical correction successfully resolved a 90-degree dorsal curvature with complete penile straightening. Erectile function was preserved, and there were no intraoperative or postoperative complications such as hematoma, infection, graft rejection, or penile shortening. Postoperative assessments revealed high levels of patient satisfaction regarding penile appearance, rigidity, and sexual performance.

Conclusion:

Tunical excision with bovine pericardial grafting is a safe, reproducible, and effective surgical option for managing severe Peyronie’s disease with significant penile curvature. It enables precise plaque removal and anatomic reconstruction, yielding excellent functional and cosmetic outcomes. This technique should be strongly considered in patients requiring advanced penile straightening and structural tunical repair.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images

None.

The authors have nothing to disclose