Tissue graft surgery for Peyronie’s disease is a procedure that involves replacing or expanding scarred penile tissue with healthy tissue or grafts. Men who have a severe bend in the penis (90 degrees or more) or who have a penis with an hourglass deformity are good candidates for tissue graft surgery. Overall, tissue graft surgery should be considered only for men who meet certain criteria.
Generally, tissue graft surgery for Peyronie’s disease is indicated for men who (1) having already attempted other medical therapy, (2) allowed time for spontaneous resolution (at least 12 months from time symptoms first appeared), and (3) have a stable condition. However, men who have preexisting erectile dysfunction , arterial insufficiency, or cavernous venoocclusive dysfunction (venous leak: a condition that can cause erectile dysfunction) are better suited for penile implant surgery with or without grafting.
During tissue graft surgery for Peyronie’s disease, surgeons use grafts of healthy tissue from another site of the body to replace or expand the scarred tunica albuginea. The vein graft is the most common, and it is usually taken from the saphenous vein, which is the long vein that runs from the top of the leg to the ankle.
This graft has a thin wall, which makes it easier to “take” to the penile tissue, and it has good elasticity. Other types of graft materials have been tried, including pig skin (porcine), Gore-Tex, and Dacron, but with varying results. Plaques are not usually removed unless they are calcified.
When vein grafts are not available, the next best graft material may include tissue from cadavers or cow pericardium. These tissue grafts are treated to minimize the risk of rejection and infection and so they serve as a matrix for host tissue to grow and replace the graft. Synthetic grafts made from materials such as Gore-Tex and Dacron have been used and the results have been variable.
Studies of tissue graft surgery for Peyronie’s disease
Seventy men who underwent tissue graft surgery for Peyronie’s disease were followed up at an average of 41.7 months. Fifty-three (75.7%) of the men said their penis was “completely straightened” while the remaining men said the residual bend was less than 20 degrees (12.8%) or more than 20 degrees (11.4%). (Kadioglu 2008)
Patient satisfaction with tissue graft surgery for Peyronie’s disease appears to diminish over time. Two studies that looked at patient satisfaction after five years found that men were dissatisfied with the results because of erectile dysfunction (occurred in 22.5% of men) or shortening of the penis (35%) in one study, while overall satisfaction declined from 86% initially to 60% at five years in another study. (Kalsi 2005; Montorsi 2004) In this latter study, shortening of the penis was a significant reason for dissatisfaction.
Side effects of tissue graft surgery for Peyronie’s disease
Studies show that the two main side effects associated with tissue graft surgery for Peyronie’s disease are shortening of the penis and erectile dysfunction. The risk of erectile dysfunction is less if plaques are not removed. Other side effects can include a mild loss of penile sensitivity, scarring around the graft, and loss of elasticity.
Kadioglu A et al. Surgical treatment of Peyronie’s disease: a single center experience with 145 patients. Eur Urol 2008 Feb; 53(2): 432-39
Kalsi J et al. The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie’s disease. BJU Int 2005 May; 95(7): 1029-33
Montorsi F et al. Five year follow-up of plaque incision and vein grafting for Peyronie’s disease. Proceedings of the Annual Meeting of the American Urologic Association, 2004 May, San Francisco CA.