title: Laser welding versus suturing in tunica vaginalis and venous patch graft corporoplasty.
abstract: 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 surgeons advocate lengthening the fibrosed corporeal bodies by excising tunica albuginea and grafting such defects to straighten the penis. Tunica vaginalis, dermis, dorsal vein and lyophilized dura have been used for this purpose. Traditionally, these graft biomaterials have been sutured to the tunica albuginea. We assessed the feasibility, short-term safety and efficacy of diode laser tissue welding using albumin based solder and indocyanine green dye to perform patch graft corporoplasty in the dog. Ten animals were subjected to bilateral transverse excision of 1 x 2 cm. sections of tunica albuginea. Corporoplasty was performed using grafts composed of saphenous vein (5) or tunica vaginalis (5). Microsurgical repair with 7-zero polydioxanone suture (10) was compared to contralateral laser welded repair (10) by recording operative time, initial and short-term bursting pressures (mean plus or minus standard deviation) and histological analysis. Operative time on the laser side (9.8 +/- 2.3 minutes) was significantly shorter (p < 0.05) than 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 mm. 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 compared to controls. Graft failure (necrosis) occurred in 3 repairs (2 laser on day 4 and 1 suture on day 10). Viable tissue with minimal differences in foreign body reaction between groups was observed in the remaining grafts. We conclude that laser welded patch graft corporoplasty using tunica vaginalis or vein is easy to perform, and provides excellent initial and short-term leak pressures. The use of laser welding in conjunction with suturing may be beneficial in corporoplasty for congenital or acquired penile curvature.
authors.affiliation: Department of Urology, J. Bentley Squier Urological Clinic, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kirsch
authors.forename: D T
authors.initials: DT
authors.lastname: Chang
authors.forename: M I
authors.initials: MI
authors.lastname: Miller
authors.forename: J P
authors.initials: JP
authors.lastname: Connor
authors.forename: T W
authors.initials: TW
authors.lastname: Hensle
authors.forename: R
authors.initials: R
authors.lastname: Shabsigh
mesh_terms: D000818:Animals; D004285:Dogs; D007834:Lasers; D008297:Male; D010413:Penis / Q000098:blood supply / Q000601:surgery*; D012501:Saphenous Vein / Q000637:transplantation; D013536:Suture Techniques; D000093667:Penile Transplantation