Surgical TechniquesPartial Plaque Excision and Grafting (PEG) for Peyronie’s Disease

Laurence A. Levine, MD

Department of Urology, Rush University Medical Center, Chicago, IL, USA

FIGURE 1

Peyronie’s disease is characterized by a fibrous inelastic scar of the tunica albuginea that often results in a penile deformity.Peyronie’s disease may present as difficulty with penetration, or penetration that causes discomfort to the partner. Men with <12months disease, progressive deformity, or painful erections may be considered candidates for non-surgical therapy, although there islimited evidence of benefit with respect to deformity reduction. Non-surgical therapies include vitamin E, colchicine, pentoxifylline,traction therapy, and vacuum therapy as well as intralesional injection with verapamil or interferon. Surgery is an option in specificinstances.

Fibrous plaque causes

penile curvature

Peyronie’s curvatureNormal tunica albuginea

seen in cross section

Fibrous plaque consistent

with Peyronie’s disease

Pentoxifylline

O

OO

N

NN

N

Intralesional injection

of verapamil or interferon

Vacuum device

© 2011 International Society for Sexual Medicine

1842 J Sex Med 2011;8:1842–1845

Surgical Techniques

FIGURE 2

Surgical reconstruction is indicated for disease that is: stable for more than 6 months, with erect deformity that is painless, a compromisedability to engage in coitus secondary to deformity and/or inadequate rigidity, and when there is extensive plaque calcification. The partialplaque excision and grafting (PEG) procedure starts with the preoperative erection deformity angle measured. A circumferential deglovingskin incision is fashioned, followed by longitudinal opening of Buck’s fascia. The neurovascular bundle is elevated if the plaque involvesthe dorsal and/or lateral surface. The PEG surgical technique involves a single partial excision of the Peyronie’s plaque centered over thearea of maximum penile curvature and/or indentation, typically carried out to the 3 and 9 o’clock positions on the shaft bilaterally. Withthe penis on full stretch, stay sutures are placed at the four corners of the defect using 4–0 polydioxanone. The corners may be extendedradially to enhance girth correction. The lateral longitudinal aspects of the defect should be equivalent, ultimately forming a rectangulardefect.

Excision of fibrous

plaque

Stay sutures

Elevated

neurovascular

bundle

Erectile tissue

Tunica albuginea

Preop measurement of penile

curvature using goniometer

Dorsal penile curvature during

preop erection

Stay sutures

Excised fibrous plaque

Intraoperative elevation of

neurovascular bundle

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Surgical Techniques

FIGURE 3

The stay sutures are used to stretch the defect and ensure accurate measurement, usually ranging from 2–5 cm longitudinally and 4–7 cmtransversely. Tutoplast (Coloplast, Minneapolis, MN, USA) Processed Human Pericardium is carefully sized to the defect. As this graftdoes not contract, only add 3–4 mm to the measured defect size in both length and width. The graft is then secured to the corners of thedefect and to the tunical edges using running 4-0 polydioxanone sutures, taking care to suture from the tunica to the graft.

Suturing of Tutoplast®

processed human pericardial

graft over defect created by

removal of fibrous plaque

using running 4-0

polydioxanone suture

Determination of Tutoplast® graft size

Elevated

neurovascular bundleStay sutures

Stay sutures

Stay sutures

Fashioning of appropriately-sized

Tutoplast® graft material

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Surgical Techniques

FIGURE 4

Buck’s fascia is closed with a running 4–0 chromic suture, and the penile skin incision is closed with interrupted 4–0 chromic sutures ina horizontal mattress fashion. The postoperative erectile angle is measured. If residual curvature warrants correction, tunica plication isrecommended. Postoperative rehabilitation includes: massage, manual stretch therapy, phosphodiesterase type 5 (PDE5) inhibitor therapy,and daily penile traction therapy is recommended to begin 2–4 weeks postoperatively for 3 months.

The Surgical TechniquesSection is sponsored in part byColoplast

Tutoplast graft sutured

over defect

Neurovascular bundle returned to

native location

Dorsal penile curvature

during preop erection

Straight penis during

postop erection

Postop compression dressing

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