title: Small intestinal submucosa for patch grafting after plaque incision in the treatment of Peyronie's disease.
abstract: OBJECTIVE
  Report the results using porcine small intestinal submucosa (SIS) as a graft material in the surgical management of Peyronie's disease (PD).
  
  
  METHODS
  We performed a retrospective chart review of men with PD who underwent surgical correction of the curvature by plaque "H" incision and patch grafting with 4-ply SIS (Cook, Bloomington, IN) by a single surgeon at our institution. Degree and direction of curvature, sexual function, and co-morbidities were assessed pre- and postoperatively.
  
  
  RESULTS
  Thirteen patients were identified. Mean age was 57 +/- 8, range 42-70 years. Median follow-up was 14 months, range 3-89 months. At presentation, all reported penile curvature. Also reported were difficulty with vaginal penetration (determined by question number 2 of the sexual encounter profile questionnaire - SEP2), palpable plaque, hourglass deformity, difficulty with firmness, and difficulty with sustaining erection (determined by SEP3) in 77%, 69%, 77%, 62%, and 46% of patients, respectively. Mean and median degrees of curvature of the primary deformity were 71 and 67.5 degrees, respectively. Three patients had secondary curves of less than 30 degrees in a different direction. Mean and median plaque size were 3.5 and 2.7 cm2, respectively. Seven patients had one graft and six patients had two grafts placed with a mean size of 15 +/- 0 cm2.
  
  
  CONCLUSIONS
  For the patient with PD, SIS grafting can achieve a functionally straight erection with durable results yet with relatively high rates of erectile dysfunction. SIS is a viable graft material for use in the surgical treatment of PD.
authors.affiliation: Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Eugene W
authors.initials: EW
authors.lastname: Lee
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010411:Penile Induration / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013552:Swine; D016896:Treatment Outcome