Plastia peneana con malla surgisis ® para la corrección de la enfermedad de Peyronie

Introduccion: La enfermedad de Peyronie (EP) consiste en la formacion de una o varias placas fibrosas en el tejido conjuntivo de la albuginea peneana. Esta alteracion puede generar una ereccion curva de grado variable, a menudo dolorosa, ocasionando gran impacto en la calidad de vida. Se reporta una prevalencia entre 3 por ciento a 9 por ciento, pero estudios mas recientes la triplican. Se han descrito variados factores de riesgo involucrados, publicandose diversos tratamientos medicos y quirurgicos, entre los que destacan plicaturas, colocacion de protesis, injertos autologos, uso de matriz extracelular de tejidos(MECT) o combinacion de estos. Presentamos nuestra experiencia con el uso de MECT de submucosa bovina (Surgisis®) en pacientes portadores de EP, analizando la morbilidad posoperatoria, los resultados esteticos y funcionales en una serie consecutiva de pacientes con seguimiento estricto. Pacientes y metodo: Desde octubre de 2007 a enero de 2009, 12 pacientes con placas indoloras mayores a 3 cms, medidas por ultrasonografia y curvaturas dorsales mayores a 35°, fueron sometidos, previo consentimiento informado, a una plastia peneana utilizando malla Surgisis®, sin resecar la placa. Todos recibieron 1 gr diario de vitamina E seis meses previos a su intervencion. Se excluyeron pacientes con disfuncion erectil severa. Bajo profilaxis con cefazolina, se diseco circunferencialmente hasta la albuginea, liberando el complejo dorsal para identificar y seccionar la placa. El tamano de la malla fue 30 por ciento mayor al lecho a reparar. Se analizaron atributos personales, resultados quirurgicos, indice de satisfaccion (escala 0 a 10) y seguimiento posintervencion (SPSS 15.0, Microsoft®).Resultados: La edad promedio fue de 54 anos (45-68). Tiempo promedio quirurgico: 56 minutos (37-75). El periodo de hospitalizacion fue de 1,5 dias (1-3). El total de los pacientes de la serie corrigio su curvatura, reportando un indice de satisfaccion estetico y funcional... Introduction: Peyronie's disease (PD) is due to the development of one or several fibrous plaques in the penile albuginia. This alteration may generate an often painful bent erection causing an impact in the quality of life. A prevalence between 3 percent and 9percent has been reported; recent studies triplicate that figure. Different medical and surgical procedures have been described. Among them, plicatures, prosthesis, implants, autologous grafts, use of extracellular tissue matrix (ETM) or a combination of them. We present our experience with ETM from bovine submucosa (Surgisis®) in patients with PD. We described postoperative morbidity, esthetic and functional results in a consecutive series of patients with close follow up. Patients and method: After obtaining informed consent, from October 2007 to January 2009, 12 patients with painless plaques measuring more that 3 cm and dorsal curvature over 35∞, underwent penileplasty with Surgisis® mesh. The plaque was not resected. Before surgery, all patients received 1 gram of Vitamin E daily for six months. Patients with severe erectile disfunction were excluded. During surgery, prophylaxis with Cefazoline was used. A circumferential dissection up to the albuginea was done. The dorsal complex was freed and the plaque was identified and sectioned. The size of the mesh was 30 percent larger than the area to be repaired. We recorded personal data, surgical results, satisfaction index (from 0 to 10) and follow up (SPSS 15.0 Microsoft®).Results: Average age was 54 (45-68). Average surgical time was 56 minutes (37-75). Hospital stay was 1.5 days (1-3). All patients corrected the curvature reporting a satisfaction index over 85 percent. Average follow up was 14 month (7-22). There were no complications. Conclusion: The use of bovine submucosa appears as an excellent procedure for the treatment of PD. The technique is simple and effective with low morbidity, good tolerance and safety.