AUA2018 V11-01 Suture-Free Sealing of Tunical Defect With Collagen Fleece

AUA2018

V11-01: Suture-free sealing of tunical defect with collagen fleece after partial plaque excision in Peyronie’s disease: Long-term outcomes of the Sealing technique

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INTRODUCTION

Grafting techniques are preferred for the surgical treatment in advanced Peyronies disease (PD) to avoid penile shortening. In this video we present the novel suture-free Sealing technique for Peyronies repair using a self-adhesive collagen fleece as an alternative to grafting. We moreover report on long-term surgical outcomes of this novel technique.

METHODS

Patients with stable PD who were unable to perform sexual intercourse were included. After partial plaque excision, the tunical defect was sealed by a self-adhesive collagen fleece (TachoSil®, Baxter, IL, USA) that does not require suture fixation. Results of correction were documented intraoperatively by artificial erection and penile length measurement. Pre- and postoperative evaluation consisted of IIEF-5 score, penile length, sonography and artificial erection.

RESULTS

From December 2004 to June 2015, n=319 patients underwent surgery. Mean patient age was 58.0 years (33-74). 78.1% of patients had dorsal deviation and 21.9% dorsolateral deviation. Mean deviation angle was 73.5° (45-110°) dorsal and 23.2° (15-40°) lateral. The Sealing technique was performed in all the cases. Mean operative time was 79.8 minutes (50-130min). Totally straightness of the penis was achieved in 299/319 (93.7%) patients. After a mean long-term follow-up of 47.2 months (12-100mon), erectile function improved in 24.5%, remained unchanged in 59.8%, and worsened in 15.7% of patients. Mean penile length before and after surgery was 13.8 cm (6-21cm) and 14.9 cm (8-22cm), respectively. 300/319 patients (94.0%) had normal glans sensation. Patient satisfaction rate was as high as 87.8%.

CONCLUSION

The Sealing technique for Peyronies repair is a safe procedure and provides reliable long-term results. It is a suture-free technique, as the collagen fleece does not need to be sewn into the tunical defect following partial plaque excision. A preparation and sewing of a graft can be omitted. Thus, operative times are reduced. The collagen fleece also provides an additional haemostatic effect. The Sealing technique moreover represents a cost-effective technique for PD reconstructive surgery.

Funding: none

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