3 YEAR FOLLOW UP AFTER MODIFIED GRID INCISION AND SEALING WITH COLLAGEN FLEECE FOR TREATMENT OF PEYRONIE'S DISEASE

초록

Introduction Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie’s plaque. Objective To assess the efficacy of technique in 32 patients with 3 year follow-up. Methods From 2018, 32 patients with stable Peyronie’s disease were included with 3 major steps of surgery; 1) dissection of neurovascular bundle/urethra according to plaque location, 2) multiple deep grid incisions of plaque for complete correction of curvature/deformity, 3) sealing with TachoSil®. Prospectively, the stretched penile length (SPL), totally straightness, penile sono, erectile function at preoperative, and 6, 12, 24, 36 months postoperatively under approval of Institutional Review Board. Results Mean age was 59.2 years (46–72). Mean curvature was 53.5 (40–80) degree, 8 with hinge and 7 with hourglass deformity. IPP was inserted in 4 and 1 at postoperative 30 months for poor erectile function. Mean follow-up was 35.4 months (12–57). Daily massage softened the hard thickening of penis gradually from 3 months until 3 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1–3 year and tunical breakage by grid incision reunited at postoperative 10–12 months. 2 patients immediately recurred dorsal curvature but most patients achieved totally straightness. Most patients gained preoperative length after 1.6 year. 96% of patients satisfied in GAQ at 2 year. Minor skin problem was occurred in two of IPP. Subcutaneous bulging hematoma was occurred in 3 patients but subsided in two within 3 months. One patients need revision surgery. In postoperative erectile function of 23 patients without IPP, spontaneous hard erection was recovered in 5 and the rest are satisfied with PED5 inhibitors. Conclusions Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea but need long term follow up for 3 years at best.