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Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie´s disease: a matched pair analysis

International Journal of Impotence Research volume 31, page 304 (2019)Cite this article

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On behalf of all authors, I would like to greatly thank Dr. Yafi for his important remarks regarding the design and results of our study. The ideal graft for Peyronie’s disease (PD) reconstructive surgery has still not been defined, despite the fact that grafting techniques are being performed for many years. One of the main reasons for this incongruity is the fact that there are no comparative studies on different grafts available. Various autologous and non-autologous grafts can be used for closure of the tunical defect following plaque incision or partial plaque excision, and each of the grafts has its advantages and disadvantages [1]. In recent years, there is a trend to use non-autologous, off-the-shelf grafts that are available and packed in various sizes, as they avoid harvesting from the patients’ body. This leads to reduced operative times and morbidity. After having tried some of the autologous and non-autologous grafts for defect closure, the author found that the novel collagen fleece (TachoSil®, Baxter, IL, USA) provides some advantages, such as (1) self-adhesive properties, meaning that the fleece does not require suture fixation into the tunical defect, (2) stretching capacity with subsequent decreased risk of contraction, (3) virtually no risk of infection, and (4) easy handling and application [2, 3]. Until now, this novel graft has met the expectations as an effective grafting material in PD reconstructive surgery, not only for grafting techniques but also for residual curvature correction during penile prosthesis implantation [4, 5].

As stated correctly by Dr. Yafi, it is without doubt that our study has significant limitations, owing predominantly to the retrospective study design and the lack of validated tools for accurate assessment of outcomes [6]. As the Peyronie’s disease questionnaire (PDQ) was not regularly assessed in past years, we did not include these data. However, this study is the first approach and attempt to compare different graft materials for PD grafting, and thus help to find the ideal graft for these sometimes challenging procedures. I agree that only by means of well-designed, comparative, prospective studies it will be possible to define the most suitable graft. Hopefully, encouraged by this first comparative study, other institutions will also try to conduct similar studies on different graft materials to further improve the quality and results of grafting techniques in the surgical management of PD. The ultimate goal will be improved patient care for this devastating and sometimes frustrating disease.

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References

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  1. Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany

    Georgios Hatzichristodoulou

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  1. Georgios Hatzichristodoulou
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Correspondence to Georgios Hatzichristodoulou.

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Hatzichristodoulou, G. Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie´s disease: a matched pair analysis. Int J Impot Res 31, 304 (2019). https://doi.org/10.1038/s41443-018-0082-y

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