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Extra-tunical grafting was a safe and effective alternative to reconstructing penile deformities associated with Peyronie's disease, a researcher reported.

Of 17 extra-tunical graft (ETG) procedures, the majority of patients had good outcomes and overall satisfaction, reported Maia VanDyke, MD, of the UT Southwestern Medical Center in Dallas.

Around 85% patients who had an ETG procedure said that their deformity was improved, and none of the patients needed further operation, VanDyke said in a presentation at the Sexual Medicine Society of North America virtual meeting.

"Our preliminary data shows extra-tunical grafting to be a promising approach to correction of severe contour deformities due to Peyronie's disease," VanDyke said. "Unlike incision and grafting, it avoids the violation of the tunica completely, thus obviating the risk of de novo erectile dysfunction."

VanDyke's group has patients with more than 3 years of follow-up, and their results have been continuous.

Peyronie's disease, a condition in which plaque builds up within the tissue of the tunica albuginea, can lead to bending or curving of the penis and may result in painful sex. More complex deformities -- such as the hourglass effect -- are rare, impacting 10%-15% of all cases, VanDyke stated.

While a number of minimally invasive treatments have been proposed to treat Peyronie's disease, surgical procedures such as penile plication, incision and grafting, and inflatable penile prosthesis remain the standard of care. In 2017, extra-tunical grafting was first introduced as a novel approach to manage patients with hourglass or indent deformities, but good erectile function. The procedure avoids making an incision in the tunica albuginea so as to not disrupt the neurovascular bundle, and thus reduces the risk of affecting sexual function.

VanDyke and colleagues reported initial results with extra-tunical grafting in the last 3 years. Of 300 penile plications, 17 patients underwent ETG between 2017 and 2020. All patients were treated at a single center by the same surgeon, using a collagen graft made from bovine pericardium (Lyoplant).

Patients were followed-up for around 200 days on average. During the procedure, penile plication was performed in 88% of patients for penile curvature. There was no observed change in mean stretched penile length, but girth increased by 1.25 cm. None of the patients required further operation or had surgical complications.

Of the 13 patients who were surveyed about a year after the procedure, 85% expressed overall satisfaction. Nine of the patients said they could feel the graft, but none reported being bothered by this. One patient reported decreased sensation. More than 75% of patients said that their deformity was much better after surgery, 8% said it was a little better, and 15% reported no change. Two patients stated that they experienced worse erectile function after surgery.

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