Peyronie's disease : endocavernous plaque excision without substitutuve graft : critical 5 years experience
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Data di Pubblicazione:
2011
Citazione:
Peyronie's disease : endocavernous plaque excision without substitutuve graft : critical 5 years experience / S. Maruccia, F. Mantovani, E. Tondelli, G. Cozzi. ((Intervento presentato al 84. convegno Congresso nazionale SIU, Società italiana urologia tenutosi a Roma nel 2011.
Abstract:
Introduction
Despite the open and actual debate about the ideal graft to use after plaque
excision in Peyronie’s disease, the Polish colleague Darewicz published his surgical experience of endocavernous plaque excision avoiding the use of
any substitutive graft. Attracted by the extreme simplification in this new
technique, we decided to verify such a surgical approach.
Materials and methods
The operation can be performed with any kind of anesthesia. We usually
prefer local anesthesia with Bupivacaine 5% 20 ml at the penis base. After
coronarie incision and cutaneous-dartoic degloving we put in evidence urethral-
cavernous axis. The albuginea is cut till erectile tissue which is moved
by blunt, few millimeters at the side of the plaque and for all its length, or at
the opposite side in case of lateral bending. Then separation of the hardened
lesion from overlying albuginea is performed with scissors or scalpel; this
cleavage plane is clearly identified just during surgery, otherwise the procedure
is converted in the traditional plaque excision and substitutive graft.
Once the plaque is removed the cavous incision is sutured and the correct
straightening is verified. The operation concludes with penile reassembly
and adherent medication. In 5 years we selected 18 cases of stabilized
disease and preserved erection but geometrically disturbed for the severe
deformity.
Results
We obtained in all cases substantial straightening, even if in 2 cases we
added a complementary minimally invasive surgery in form of plication, and
2 cases were converted in graft technique. At beginning we isolated dorsal
neurovascular bundle, in a second phase, discovering the easy dissection
of the sinechial plan separating the albuginea from the lesion, this was not
anymore necessary. Even without the use of substitutive graft it is palpable -
for at least 3 months - an increased consistency in the dorsal side.
Conclusions
Case studies and current controls allow us to say that the impression is quite
good: learning curve is quick and the surgical technique is unquestionably
shortened and simplified, without isolation of the dorsal neurovascular bundle,
without the necessity of autologous tissue or heterologous matrices to
be inserted, allowing a more comfortable post-operative course and a more
rapid and easier functional recovery. Peyronie’s disease surgery represents
for all surgeons a hard path, our primary goal is to make it easier and more
gratifying in the results.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
S. Maruccia, F. Mantovani, E. Tondelli, G. Cozzi
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