Dr Aditya Prakash Sharma
PGIMER, Chandigarh
Peyronie's disease necessitates nuanced surgical approaches, with bovine pericardium emerging as a promising graft material in plaque excision and grafting procedures. Bovine pericardium serves as an optimal substrate, offering structural support for penile tissue reconstruction during plaque excision and grafting. The xenogeneic nature of bovine pericardium enhances graft integration, minimizing the risk of adverse reactions due to its low immunogenicity. Its bio-mimetic properties foster a favorable microenvironment for tissue regeneration, reducing complications associated with foreign body response.
Acellular tissue engineered pericardial patch (SynkroMax Biotech Private Limited, India) is available in dimensions of 4 cm×4 cm and 6 cm×6 cm. It has a thickness ranging from 2 mm to 5 mm. Its quality is standardized and it is available in a sterile packaging that is ready to use and contains non glutaraldehyde solution.
The surgical procedure involves a subcoronal or midline dorsal incision, meticulous dissection of the neurovascular bundle, and Gitte’s test for curvature assessment (Figure 1A). An H-shaped incision is made on the plaque, excising it with care to protect cavernosal tissue (Figure 1B). The bovine pericardial patch (SynkroMax Biotech) is secured 2–3 mm larger than the defect using PDS 3-0 or 4-0 sutures (Figure 1C). A continuous 4-0 monofilament suture secures the patch and corrects curvature, with additional plications if needed (Figure 1D, E). This precise technique aims for effective plaque removal and secure patch application, ensuring optimal tissue reconstruction and curvature correction.
The limitations include the graft's limited stretch and elasticity compared to human tissue, potentially affecting its adaptation to physiological changes. Cost considerations may hinder accessibility for certain patient populations, and the long-term durability of bovine pericardium grafts requires further investigation. In conclusion, while bovine pericardium shows promise in Peyronie's disease surgery, ongoing research is essential to address challenges and determine the graft's ability to withstand dynamic forces over time.