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Kalsi JS, Christopher N, Ralph DJ, Minhas S. Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease. BJU Int 2006;98:110-115.

The angulation that occurs as a result of the plaque in Peyronie’s disease (PD) can be successfully corrected using the Nesbit procedure but this can result in a significant amount of penile shortening. In this paper we see a commercially available human fascia lata (Tutoplast) utilized to correct a small number of deformities after incision of the penile plaque. By using this graft no second procedure to obtain the graft material is required, such as the Saphenous vein harvesting in the Leu procedure, thus avoiding morbidity and lengthened procedure time.

14 patients, including 4 with diabetes, had penile plaque incision and Tutoplast grafting. Seven patients suffered with erectile dysfunction (ED) pre-operatively responsive to phosphodiesterase-5 inhibitors or intercavernosal therapy and 3 had previously undergone a Nesbit procedure. The PD had been stable in all patients for at least 1 year. Deformity was assessed with alprostadil in the outpatient department and again at time of surgery and the stretched penile length was also recorded. The degree of penile deformity, quality of erection and penetration were used to assess outcome.

The average penile deformity pre-operatively was 67.2 (20-90) degrees. 6 patients had undergone previous penile surgery or had a complex deformity requiring additional plication sutures in addition to the graft(s). 10 patients had one, three had two and one had three grafts during the procedure. The penis was completely straight in 11 of 14 patients and 13 had a satisfaction rate of excellent or satisfactory overall. There was no penile shortening in 10 patients and only one developed de novo ED managed with alprostadil. One patient with penile shortening was unable to have intercourse, it is not clear whether those with penile shortening were the patients that required additional sutures. The results are comparable to other graft materials despite some complicated deformities being corrected without the need for an operation to attain graft material. The mean follow up at publication was 31 months so long-term results for this graft in this setting are unknown but it may be a useful material. The risk of penile shortening or the development of ED is still present.