Penile Straightening With Plaque Incision or Partial Excision and Human Pericardial Grafting Technique

Abstract

Penile reconstruction for Peyronie’s disease may require advanced techniques of plaque incision or partial excision when the deformity is severe. This technically challenging procedure is indicated for men with good-to-excellent preoperative erectile capacity and erect penile curvature exceeding 60° or unstable penis or hinge effect caused by severe indentation or hourglass deformity. Various grafts have been used historically, including fat, dermis, fascia, vein, and more recently, processed cadaveric tissue that can be “taken off the shelf,” which can shorten operative time and avoid a second incision at the donor site. These procedures require attention to detail in defining the deformity, careful elevation of the neurovascular bundle, incision or partial excision of the plaque, and proper sizing of the graft to repair the tunical defect. A comprehensive informed consent is critical to detail possible postoperative issues, including loss of penile length, diminished sexual sensation, incomplete or recurrent curvature, and, most important, erectile dysfunction. This chapter describes the plaque incision/partial excision procedure using the modified “H” incision and pericardial grafting technique.