LASER-WELDING VERSUS SUTURING IN TUNICA VAGINALIS AND VENOUS PATCH GRAFT CORPOROPLASTY

Congenital penile curvature may result from corporeal disproportion in nearly 40% of cases, while in adults scarring of the corporeal bodies or periurethral fibrosis accounts for the majority of cases. Some sur geons advocate lengthening the fibrosed corporeal bodies by excising t unica albuginea and grafting such defects to straighten the penis. Tun ica vaginalis, dermis, dorsal vein and lyophilized dura have been used for this purpose. Traditionally, these graft biomaterials have been s utured to the tunica albuginea. We assessed the feasibility, short-ter m safety and efficacy of diode laser tissue welding using albumin base d solder and indocyanine green dye to perform patch graft corporoplast y in the dog. Ten animals were subjected to bilateral transverse excis ion of 1 x 2 cm. sections of tunica albuginea. Corporoplasty was perfo rmed using grafts composed of saphenous vein (5) or tunica vaginalis ( 5). Microsurgical repair with 7-zero polydioxanone suture (10) was com pared to contralateral laser welded repair (10) by recording operative time, initial and short-term bursting pressures (mean plus or minus s tandard deviation) and histological analysis. Operative time on the la ser side (9.8 +/- 2.3 minutes) was significantly shorter (p <0.05) tha n on the suture side (17.1 +/- 5.1 minutes). Leak pressures, initially (laser 105.7 +/- 23.8 mm. Hg versus suture 35.3 +/- 8.0 mm. Hg), at 3 to 5 days (greater than 333.3 +/- 62.4 mm. Hg versus 136.6 +/- 39.4 m m. Hg) and at 7 to 10 days (greater than 397.8 +/- 39.8 mm. Hg versus 191.5 +/- 46.4 mm. Hg) were higher (p <0.05) in the laser side compare d to controls. Graft failure (necrosis) occurred in 3 repairs (2 laser on day 4 and 1 suture on day 10). Viable tissue with minimal differen ces in foreign body reaction between groups was observed in the remain ing grafts. We conclude that laser welded patch graft corporoplasty us ing tunica vaginalis or vein is easy to perform, and provides excellen t initial and short-term leak pressures. The use of laser welding in c onjunction with suturing may be beneficial in corporoplasty for congen ital or acquired penile curvature.