TachoSil® grafting in tunical lengthening surgery for Peyronie's disease: a single-center experience

Injerto de TachoSil® en la cirugía de alargamiento tunical para la enfer-medad de Peyronie: una experiencia en un solo centro

Background: In patients with Peyronie’s disease with severe/complex penile deformities, a tunical lengthening procedure with grafting is recommended. However, it is unclear which graft is the best. We aim to evaluate the use of TachoSil®, a collagen fleece hemostatic patch, at a single high-volume center. Methods: We conducted a retrospective study including all patients who underwent tunical lengthening with TachoSil® at our center until June 2024. Demographic data, personal history, erectile function, characteristics of the curvature and the fibrotic plaque, complications and surgical outcomes were collected. Questionnaires were applied to evaluate patient-reported outcomes and satisfaction. Results: A total of 31 patients, 58.38 ± 5.24 years old, underwent the procedure. There was a high postoperative straightness rate and most patients were satisfied with the surgery (73.9%). There was a statistically significant increase in stretched penile length immediately after surgery (p = 0.017), despite a reported decrease in penile length after surgery in 74.2% of the patients. There was a significant decrease in International Index of Erectile Function-5 scores postoperatively (p = 0.001), with a rate of de novo erectile dysfunction (ED) of 43.3%, though mild in almost all cases. Conclusions: Our findings suggest acceptable results with TachoSil® grafting in terms of patient satisfaction, effective curvature correction and manageable complications. Despite a high incidence of de novo ED, most cases were mild and responsive to oral therapy. Complications such as reduced rigidity, glans hypoesthesia and subjective loss of penile length—though largely undocumented objectively—emerged as notable patient concerns.

Resumen

Antecedentes: En pacientes con enfermedad de Peyronie con deformidades penianas severas/complejas, se recomienda un injerto de alargamiento tunical. Sin embargo, no está claro cuál injerto es el mejor. Nuestro objetivo es evaluar el uso de TachoSil®, un apósito hemostático de colágeno, en un solo centro de alto volumen. Métodos: Realizamos un estudio retrospectivo que incluyó a todos los pacientes que se sometieron a alargamiento tunical con TachoSil® en nuestro centro hasta junio de 2024. Se recopilaron datos demográficos, antecedentes personales, función eréctil, características de la curvatura y la placa fibrosa, complicaciones y resultados quirúrgicos. Se aplicaron cuestionarios para evaluar los resultados informados por los pacientes y la satisfacción. Resultados: Un total de 31 pacientes, con una edad promedio de 58.38± 5.24 años, se sometieron al procedimiento. Hubo una alta tasa de rectitud postoperatoria y la mayoría de los pacientes estaban satisfechos con la cirugía (73.9%). Hubo un aumento estadísticamente significativo en la longitud del pene estirado inmediatamente después de la cirugía (p = 0.017), a pesar de una disminución reportada en la longitud del pene después de la cirugía en el 74.2% de los pacientes. Hubo una disminución significativa en las puntuaciones del Índice Internacional de Función Eréctil-5 postoperatoriamente (p = 0.001), con una tasa de disfunción eréctil (DE) de novo del 43.3%, aunque leve en la mayoría de los casos. Conclusiones: Nuestros hallazgos sugieren resultados aceptables con el injerto de TachoSil® en términos de satisfacción del paciente, corrección efectiva de la curvatura y complicaciones manejables. A pesar de la alta incidencia de DE de novo, la mayoría de los casos fueron leves y respondieron a la terapia oral. Complicaciones como la reducción de la rigidez, la hipoestesia del glande y la pérdida subjetiva de longitud del pene—aunque en gran medida no documentadas objetivamente—emergieron como preocupaciones notables para los pacientes.

Penile lengthening; Peyronie’s disease; TachoSil

Palabras Clave

Alargamiento del pene; Enfermedad de Peyronie; TachoSil

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