Long-term follow-up on use of pericardial graft in the surgical managementof Peyronie's disease

We have previously reported on the use of Tutoplast((R)) cadaveric pericard ium as an alternative material for grafting the tunica albugineal defect af ter Peyronie's plaque excision with satisfactory results in 11 patients. We now review long-term outcomes in this cohort of men, Eleven patients with significant penile curvature interfering with sexual intercourse were evalu ated after at least 12 months of conservative therapy. All patients underwe nt pre-operative evaluation, including penile duplex Doppler ultrasound stu dies. Chemically processed and gamma-irradiated pericardium (Biodynamics In ternational, Parsippany, NT) was used to graft the cavernosal defect after surgical excision of the penile plaque, Three patients simultaneously under went placement of penile prostheses secondary to documented erection proble ms identified at duplex Doppler ultrasound evaluation, The long-term postop erative complications and erectile function were evaluated with a mean foll ow-up of 30 months (range 25-35 months), All patients reported resolution o f penile curvature allowing for normal sexual function after a mean follow- up of the first 14 months. Thirty months after placement of cadaveric peric ardium, the three prosthetic patients still reported excellent sexual funct ion, For the eight patients who did not undergo placement of a prosthesis, three with small to medium plaque size (<2 x 5 cm) continued to do well. Th e remaining five patients with a large plaque size (>2 x 5 cm) did well ini tially, but later reported difficulty maintaining erection due to venous le akage, thus they are currently using either a vacuum constriction device or an Actis ring. Three out of these five venous leakage patients had ventral plaques; two had dorsal plaques, one of significant size (4 x 5 cm), We co nclude that for those patients who do not undergo placement of a prosthesis , a better long-term outcome is observed when the plaque is small to medium in size (<2 x 5 cm) and dorsally located, Patients with ventral plaque, ex treme curvature, or plaque size >4 x 5 cm were more likely to have venooccl usive dysfunction, necessitating further intervention.