Could plaque excision surgery with sis graft induce a new fibrotic reaction in la Peyronie's disease patients?
OBJECTIVE
Peyronie's disease is an acquired disorder of tunica albuginea characterized by the formation of a fibrous plaque which may be associated with pain during erection, penile shortening and/or curvature, difficult vaginal penetration and erectile dysfunction. Severe deformity and/or intractable erectile dysfunction require surgical management. The plaque excision with grafting technique requires the complete excision of the fibrotic tissue and its replacement with an autologous or eterologous graft; among the latter, porcine small intestine submucosa graft is widely used. Nowadays, it is not known if the unsatisfactory results of this surgery caused by a fibrotic process are directly determined by the graft material.


METHODS
A 50 year-old patient with a severe dorsal penile curvature (> 90 degrees) not allowing penetration, without erectile dysfunction underwent plaque excision surgery with porcine small intestine submucosa grafting. Soon after the surgical intervention a new and progressive penile shortening with a penile dorsal curvature and a erectile dysfunction appear, and thus, six months later, a new plaque excision surgery with saphenous vein graft and penile prosthesis implantation was performed. During the first intervention, plaque and peri-plaque tissue were excised and analyzed, whilst during the second intervention fibrotic tissue on the graft and tissue around it were excised and analyzed, too.


RESULTS
In the tissues excised during the second intervention, fibrosis was present either in graft or in peri-graft tissue. Around the graft material, a gigantocellular reaction (foreing body-like) was present and ossification was present, too.


CONCLUSIONS
This type of inflammatory cellular component is associated with foreign body reactions and was never described in Peyronie's disease. Our results suggest that plaque excision surgery with SIS graft could induce the formation of a new cicatritial plaque, not directly correlated to Peyronie's disease, causing the formation of a new plaque and a new penile curvature.
Rolle
Luigi
L
Divisione Universitaria di Urologia, Ospedale San Giovanni Battista "Molinette", Università degli Studi di Torino, Italy. massimiliano.timpano@fastwebnet.it
Tamagnone
Andrea
A
Bollito
Enrico
E
Ceruti
Carlo
C
Timpano
Massimiliano
M
Negro
Carlo Luigi Augusto
CL
Galletto
Elisa
E
Fontana
Dario
D
D000818:Animals; D005355:Fibrosis / Q000209:etiology; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000473:pathology / Q000601:surgery*; D010413:Penis / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology; D013552:Swine; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods