Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany.
Department of Urology, Menoufia University, Al Minufiyah, Egypt.
Int J Impot Res. 2019 Jul;31(4):256-262. doi: 10.1038/s41443-018-0071-1. Epub 2018 Sep 7.
Advanced Peyronie's disease (PD) with severe penile curvature requires grafting following plaque incision or partial plaque excision. So far, the ideal graft material has not been identified although various grafts have been studied. In this first matched pair analysis we compared the outcome after grafting with small intestinal submucosa (SIS) and self-adhesive collagen fleece (CF). We retrospectively identified 43 patients after SIS grafting with complete follow-up data sets to be eligible for the present study. A total of 43 patients after CF grafting were matched case by case to the SIS group using the degree of preoperative penile curvature as the primary matching factor. Postoperative outcome was compared with the focus on penile straightening, penile length, potency, relapse rates and long-term complications. Median degree of curvature was 80° in each group. Mean follow-up periods were 31 months after SIS and 39 months after CF grafting. The CF grafting procedure was significantly faster than SIS grafting (80 vs. 104 min, p < 0.001). No major short-term complications were observed. Both techniques gained good long-term penile straightening rates. Relapse of penile curvature was observed after SIS grafting only. Postoperative penile shortening occurred more often after SIS grafting (28% vs. 5%, p = 0.007). With a mean preoperative IIEF-5 score of 16, the SIS cohort significantly differed from the CF cohort with a mean IIEF-5 score of 19 (p = 0.016). The median IIEF-5 score improvement was higher after SIS grafting (+4.5 vs. +1, p = 0.002). Diminished penile sensation was the main long-term side effect with low rates after both procedures (9% and 7% in the SIS and CF group respectively, p = 0.100). In this first matched pair analysis both techniques showed promising long-term results. CF seems to have advantages regarding duration of surgery and preserving penile length. More comparative studies with larger collectives are desirable.
严重的 Peyronie 病（PD）需要在斑块切开或部分斑块切除后进行移植。尽管已经研究了各种移植物，但到目前为止，还没有确定理想的移植物材料。在这项首次匹配对分析中，我们比较了使用小肠黏膜下层（SIS）和自粘胶原绒毡（CF）进行移植后的结果。我们回顾性地确定了 43 例 SIS 移植后具有完整随访数据集的患者符合本研究条件。使用术前阴茎弯曲程度作为主要匹配因素，对总共 43 例 CF 移植后的患者进行了病例匹配。比较了术后结果，重点是阴茎伸直、阴茎长度、勃起功能、复发率和长期并发症。每组的中位弯曲度为 80°。SIS 组和 CF 组的平均随访时间分别为 31 个月和 39 个月。CF 移植手术明显快于 SIS 移植手术（80 分钟与 104 分钟，p<0.001）。未观察到主要短期并发症。两种技术均获得了良好的长期阴茎伸直率。仅在 SIS 移植后观察到阴茎弯曲复发。SIS 移植后更常发生术后阴茎缩短（28%与 5%，p=0.007）。SIS 队列的平均术前 IIEF-5 评分为 16，与 CF 队列的平均 IIEF-5 评分 19 有显著差异（p=0.016）。SIS 移植后 IIEF-5 评分的中位数改善更高（+4.5 与+1，p=0.002）。术后阴茎感觉减退是两种手术的主要长期副作用，但发生率较低（SIS 组和 CF 组分别为 9%和 7%，p=0.100）。在这项首次匹配对分析中，两种技术均显示出有前景的长期结果。CF 似乎在手术持续时间和保持阴茎长度方面具有优势。需要进行更多具有更大样本量的比较研究。
