Login to Access Video or Poster Abstract: MP56-09
Sources of Funding: none

Introduction

Implant with grafting is the gold standard approach to men with severe curvature and concurrent severe erectile dysfunction. Hatzichristodoulou et al have shown excellent results with the use of Tachosil, an equine graft coated with fibrinogen and thrombin that is self-adherent and does not require suture fixation for Peyronie's repair without implant. We review our now intermediate series of patients who received a Tachosil graft in addition to an inflatable penile prosthesis (IPP), an expeditious approach that obviates possible device puncture.

Methods

Surgical technique involved a circumcision incision without or without separate peno-scrotal incision for implant placement. The IPP (Coloplast Titan) was placed first and inflated to reveal true degree of curve (often greater than pre-operative Doppler curve assessment). The dartos layer was dissected off and preserved providing coverage of the tachosil graft. The neurovascular bundle was next elevated if necessary which often resulted in significant dorsal curve improvement. Plaque incision(s)/partial excisions were performed at the point(s) of maximum deflection. Upon re-inflation the new enlarged defect was covered with a tachosil graft. The tachosil was then molded to the penis and covered with previously preserved dartos layer. A catheter and compressive dressing are left overnight. The device was left inflated for 4 weeks following the procedure.

Results

Twelve patients underwent IPP with tachosil graft. Average age of patients was 56. The average pre-operative curvature was 75 degrees (45-120) on doppler. Curvature was multiplanar dorsolaterally (left) in 11/13 patients. Average time was 145 minutes with < 100 ml of blood loss. Mean follow up time is 10 months. One patient developed an infection which necessitated device removal. There have been no signs of device aneurysm to date. Curvature correction was < 30 degrees in 12/13 patients with one patient having residual 40 degree lateral curvature with max inflation. Several patients have lateral deflection with the device uninflated. Two patients had Xiaflex injections prior to their procedure which did not appreciably influence the difficulty of the case.

Conclusions

Our intermediate results continue to reveal that Tachosil offers a feasible, fast and safe alternative to grafting with IPP that does not require the graft to be sewn in place.

Funding

none