Comparison of Short- and LONG-TERM Sexual Results of Grafts used in the Surgical Treatment of Peyronie's Disease Grafting


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ankara Yildirim Beyazit University, Tıp Fakültesi, Üroloji Ana Bilim Dalı, Turkey

Approval Date: 2021

Thesis Language: Turkish

Student: Türker SOYDAŞ

Supervisor: ÖNDER KAYIGİL

Abstract:

Aim: In our study, it was aimed to compare the short and long term sexual results of the use of autologous venous graft, porcine pericardial extracellular matrix graft, porcine intestinal submucosal extracellular collagen matrix graft and bovine pericardial extracellular matrix graft in the surgical treatment of Peyronie's Disease. Materials and Methods: In our study, a complaint of concomitant erectile dysfunction with penile curvature greater than 40 degrees and/or complex penile deformity (hourglass deformity, hinge effect, ventral curvature to prevent penetration) was admitted to the urology outpatient clinic due to penile curvature between October 2014 and February 2020. In this study, it was planned to retrospectively evaluate the patients who underwent surgical treatment of Peyronie's Disease with a graft due to the presence of Peyronie's plaque without arterial or venous insufficiency in the cavernosometry and penile color Doppler ultrasonography examinations, and to compare the postoperative results according to the graft materials used. The patients were grouped according to the graft material applied: autologous venous graft, porcine pericardial extracellular matrix graft, porcine intestinal submucosal extracellular collagen graft, and bovine pericardial extracellular matrix graft. The obtained groups were determined by the effects of preoperative comorbid diseases on surgical success, operation time, postoperative short and long term IIEF-5 scores; It was planned to retrospectively evaluate the results of the graft materials by comparing them in terms of development of postoperative curvature, wound infection, hematoma, incision contracture, cavernous leak, ballooning, hypoesthesia in the inguinal region, painful plication suture, palpable suture, loss of sensation and penile length loss. Results: In our clinic, 155 patients who underwent surgical treatment of Peyronie's Disease with graft between October 2014 and February 2020 were detected. Considering the distribution between the groups, it was evaluated that there were 36 patients with autologous venous grafts, 40 with porcine pericardial extracellular matrix graft, 36 with porcine intestinal submucosal extracellular collagen matrix graft, and 43 with bovine pericardial extracellular matrix graft. In terms of the compared parameters, the operation time of the patients who used autologous venous grafts was significantly longer than the other graft groups (p<0.05). As the degree of curvature increased, it was found that loss of sensation and penile shortening increased statistically significantly (p<0.05). Conclusion: A statistically significant difference was found between the degree of penile curvature and loss of sensation, and between the degree of penile curvature in terms of penile shortening and graft materials in terms of operation time. No significant difference was observed between the extracellular matrix grafts, which would be a reason for selection, and prospective randomized controlled studies with larger patient groups are needed.