Tips and Tricks for Plaque Excision and Grafting in Peyronie’s Disease

Abstract

Introduction and Objectives:

Peyronie’s disease is a localized fibroproliferative disorder characterized by abnormal collagen deposition within the tunica albuginea, leading to penile deformity, shortening, and erectile dysfunction. Surgical plaque excision with grafting is reserved for men with stable disease, significant curvature (>60°), hourglass deformity, or inability to penetrate who maintain adequate erectile rigidity. Despite durable correction, curvature recurrence occurs in approximately 15% of patients after plaque incision/excision with grafting. This video demonstrates a step-by-step approach for plaque excision and grafting in a complex dorsal–lateral deformity using a Tutoplast®-processed pericardium allograft, emphasizing key technical pearls to optimize surgical outcomes and minimize contracture risk.

Methods:

A 58-year-old man with a 2-year history of penile pain and progressive upward “U-shaped’’ curvature (75° dorsal, 30° left lateral) underwent corrective surgery. Preoperative workup included pharmacologic penile duplex ultrasound confirming normal cavernosal inflow and intact veno-occlusive function. Under general anesthesia, a subcoronal circumcision and complete degloving were performed. Buck’s fascia was opened, and the neurovascular bundle was carefully mobilized. After artificial erection and base tourniquet placement, the densely calcified dorsal plaque was sharply excised, preserving corporal spongiosa; tunical edges were freshened, and quadrant 4-0 polydioxanone stay sutures were placed. The tunical defect was measured and reconstructed with an acellular allograft upsized ∼20% for anticipated contraction, inset with running 4-0 polydioxanone after quadrant fixation. A repeat artificial erection was performed to assess the repair and hemostasis, followed by layered closure (dartos 3-0, skin 4-0), regional penile blocks, and a compressive dressing; no drains or urethral catheter were used. It is important to mention that Tutoplast® processed pericardium was used in this case, providing a sterile human graft with preserved collagen structure for strength and tissue integration.

Results:

Intraoperative artificial erection after graft placement demonstrated complete correction of the preoperative deformity to a straight shaft without residual hinge or hourglass. Total operative time was 240 minutes, with an estimated blood loss of ∼100 mL. There were no intraoperative complications or needed transfusions. The patient was extubated in the operating room, recovered uneventfully in Post Anesthesia Care Unit (PACU), and was discharged home the same day with a compressive dressing and routine follow-up planned at 6 weeks. Seven months after the procedure, the patient reported erectile function and was able to achieve penetration. At 7 months postoperatively, the patient reported preserved erectile function and successful penetrative intercourse, without recurrent curvature.

Conclusion:

Plaque excision and grafting remain the gold-standard reconstructive option for complex Peyronie’s deformities with preserved erectile function. Success depends on meticulous neurovascular bundle handling, precise plaque delineation, accurate defect sizing, and slight graft oversizing to reduce contracture.

Patient Consent:

Written informed consent for publication of the clinical material and accompanying video was obtained from the patient.

Funding Information:

The authors declare that no funding, grants, or other financial support were received for this work.

The authors declare that they have no conflicts of interest relevant to this work.

Runtime of video:

7 mints 09 secs.