Hatzichristodoulou Georgios, Tsambarlis Peter, Kübler Hubert, Levine Laurence A
Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Transl Androl Urol. 2017 Aug;6(4):645-656. doi: 10.21037/tau.2017.07.17.
Grafting techniques in the surgical management of Peyronie's disease (PD) are challenging, especially in inexperienced hands. In order to improve surgical outcomes the urologist should follow a standard surgical approach, preferably of an established and reliable grafting technique. The aim of this study is to provide tips and tricks for graft surgery for PD.
This report offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the partial plaque excision and grafting (PEG) procedure. Two senior surgeons (GH, LAL) describe their surgical technique in detail, and provide important aspects and tips one has to be aware of when performing a grafting technique in patients with PD. Special attention is also paid to preoperative considerations and adequate patient counseling. Moreover, postoperative penile rehabilitation programs are discussed.
Adequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy.
The present paper offers a step-by-step tutorial for grafting techniques in PD, especially for the Sealing technique and the PEG procedure, in order to help the reader to understand major steps during surgery and to avoid pitfalls. Careful patient selection, a reliable and established surgical technique and a postoperative rehabilitation program are main predictors for treatment success. In summary, the ultimate goal should be improved patient care, safety and satisfaction.
佩罗尼氏病（PD）手术治疗中的移植技术具有挑战性，尤其是在经验不足的医生手中。为了提高手术效果，泌尿科医生应遵循标准的手术方法，最好是采用成熟可靠的移植技术。本研究的目的是提供PD移植手术的技巧和窍门。
本报告提供了PD移植技术的分步教程，特别是密封技术和部分斑块切除及移植（PEG）手术。两位资深外科医生（GH，LAL）详细描述了他们的手术技术，并提供了在对PD患者进行移植技术时必须注意的重要方面和技巧。还特别关注术前考虑因素和对患者进行充分的咨询。此外，还讨论了术后阴茎康复计划。
对患者进行充分的术前咨询至关重要，应包括可能的不良反应和负面结果，如持续或复发的弯曲、阴茎头感觉减退、勃起功能减退或阴茎缩短。移植技术的正确适应症至关重要。在移植技术过程中有许多手术细节，必须加以考虑以获得最佳结果。这些包括神经血管束的正确准备、随后在不损伤下方勃起组织的情况下进行部分斑块切除，以及对由此产生的白膜缺损进行充分闭合。缺损闭合可通过心包移植（PEG手术）或胶原绒（密封技术）等移植材料完成。术后，患者应至少6周避免性行为，并遵循阴茎康复计划，包括使用5型磷酸二酯酶抑制剂、手动拉伸、阴茎按摩和阴茎牵引治疗。
本文提供了PD移植技术的分步教程，特别是密封技术和PEG手术，以帮助读者理解手术中的主要步骤并避免陷阱。仔细的患者选择、可靠且成熟的手术技术以及术后康复计划是治疗成功的主要预测因素。总之，最终目标应是改善患者护理、安全性和满意度。
