Corporoplasty with small soft axial prostheses （VIRILIS ） and bovine pericardial graft （HYDRIX） in Peyronie＇s disease

The surgical techniques used by Austoni and Egydio in the treatment of Peyronie＇s disease are based on geometric principles. The aim of this paper is to report our multicentric experience and technical changes to Austoni＇s original technique, focusing on several tips and tricks to make this technique easy to perform, even by less experienced practitioners. We performed operations in three different Italian institutions. We implanted a small soft Virilis I~ axial prostheses （Ф 7 Fr.）, using a bovine pericardium collagen matrix patch （Hydrix） to cover the defect in the tunica albuginea. Sixty patients with a mean age of 58 years （range 44-76 years） underwent surgery between September 2005 and January 2010. After surgery, mean lengthening of the shaft was 2 cm （range 1.2-2.3 cm） with complete correction of penile recurvatum. Thirty-nine patients resumed sexual activity 60 days later, 14 after 90 days and 7 after 120 days. The international index of erectile function （IIEF） score was 15.5 before surgery and it improved to 23 at 12 and 24 months after surgery. Furthermore, the visual analogue scale （VAS） showed good results in terms of the recovery of natural sexual intercourse （over 80% of couples） and of the original length and girth of the penis. The soft implant we used takes advantage of erection that occurs spontaneously, using the residual erection of the spared cavernous tissue. The method is easy to learn and reproducible, and the use of pericardium speeds up the operation, while also covering large defects of the tunica albuginea that result from complex recurvatum.

Penile mass formation after neglected penile fracture:Surgical management with pericardial graft reinforcement

Background:Penile fracture is defined as the rupture of the tunica albuginea of the corpora cavernosa while in an erect state,during mostly intercourse or masturbation.Diagnosis of such condition is mainly clinical,while on the other hand,seeking medical attention is often delayed,and treatment options depend upon the time of presentation.Methods:This case report details a patient who developed a penile cystic fibro-hematoma lesion,2 months after a neglected penile fracture.After proper assessment including detailed history,physical exam and a penile doppler ultrasound,patient was elected for surgery.Results:The patient underwent surgical removal of the mass,correction of the curvature,and reinforcement of the weakened tunica albuginea with a pericardium graft.Postoperative course was uneventful.At follow-up,he reported normal erectile function with resolved penile curvature.Conclusion:This highlights the importance of seeking prompt medical attention for suspected penile fractures to avoid potential long-term complications.

Evaluation of corporal fibrosis in cadaveric pericardium and vein grafts for tunica albuginea substitution in rats

<abstract>Abstract Aim: To evaluate the degree of corporal fibrosis in rats with cadaveric pericardium or vein as grafting materials for tunica albuginea substitution. Materials and methods: Thirty male Sprague-Dawley rats (300 g-325 g) were divided at random into 3 groups of 10 animals each: group 1 was the sham-operated controls and groups 2 and 3 underwent wedge excision of tunica albuginea and replacement with cadaveric pericardium and vein grafts, respectively. Four months later, rats were sacrificed and the penis removed to assess the degree of fibrosis using RT PCR technique for TGP-β1 mRNA expression. The tissues were fixed in 10 % formalin, paraffin-embedded and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibers. Results: Four months after grafting, there was minimal fibrosis surrounding the patch in the vein graft rats and moderate fibrosis in the pericardial graft rats. The degree of penile fibrosis in the pericardial graft rats was significantly higher than that in the controls (P<0.01), but in the vein graft rats it was not significantly different from that of the controls (P>0.05). Conclusion: The degree of penile fibrosis of cadaveric pericardial graft was significantly higher than that of the control group, while in the vein graft group it was comparable to the latter. The authors believe that the vein graft may be a more ideal substance to be used as the tunica albuginea substitute than the pericardial graft in the surgical treatment of Peyronie's disease.