Graft materials in Peyronie's disease surgery: a comprehensive review.
OBJECTIVE
To discuss the currently used graft materials in Peyronie's surgery.


METHODS
A MEDLINE search was conducted till the end of September 2006 on the surgical treatment of Peyronie's disease, and all aspects of the graft materials used for Peyronie's surgery were examined.


RESULTS
Currently available interposing graft materials may be classified in three categories: autologous tissues, extracellular matrix (ECM) tissues, and synthetic materials. Each grafting material in these categories has its own advantages and drawbacks in terms of tissue properties, antigenicity, availability, and cost-effectiveness. Saphenous vein grafts are the most widely used among autologous grafts, with acceptable functional outcomes in the long term. Other graft materials include tunica vaginalis, fascia lata, rectus fascia, and buccal mucosa, with variable results. Despite numerous advantages in terms of tissue compatibility, the major drawback of autologous grafts is tissue harvesting that to morbidities and longer operative durations. For this reason, the use of readily available ECM tissues as the products of tissue engineering is recommended by some authors. Among ECM grafts, cadaveric and bovine pericardia have satisfactory mid-term outcomes. However, longer follow-ups with an adequate number of patients are lacking. On the other hand, recent evidence suggests that small intestinal submucosa may be associated with high rate of operative failure and complications. Generally, synthetic materials are no longer used in grafting procedures in Peyronie's surgery because of their antigenicity and inappropriate functional properties. For prosthesis surgery, pericardia as well as autologous rectus fascia grafts are probably the most suitable graft materials because of their suitable tissue characteristics that satisfy the mechanical demands of the prosthesis.


CONCLUSIONS
Saphenous vein grafting from autologous tissues and pericardium from ECM tissues have satisfactory results. However, further research and clinical studies are needed in order to determine the optimal graft material.
Kadioglu
Ates
A
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey. Electronic address: kadiogluates@ttnet.net.tr.
Sanli
Oner
O
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
Akman
Tolga
T
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
Ersay
Ahmet
A
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
Guven
Selcuk
S
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
Mammadov
Firdovsi
F
University of Istanbul, Istanbul Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
D001672:Biocompatible Materials / Q000627:therapeutic use; D005109:Extracellular Matrix / Q000637:transplantation*; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000637:transplantation*; D010411:Penile Induration / Q000601:surgery*; D010496:Pericardium / Q000637:transplantation*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014680:Veins / Q000637:transplantation
D001672:Biocompatible Materials