Análise matemática e solução computadorizada para enxertia nas curvaturas penianas

Abstract

The Peyronie s disease affect 9% of the male population and the treatment, when they have a significant deformity, is made by surgery. The technic capable to correct complex deviations (multiplanar and hourglass) and prevent length loss is plaque incision and graft (PIG) but at the same time they have higher rate of erectile dysfunction (ED), when compared with plication. Looking for a better comprehension about the mechanical and geometrical consequences of PIG on penile curvature correction we reproduce the most common surgical technic to perform PIG, using a three-dimensional cylinder model. We found significant geometrical and mechanicals problems. We can conclude that ED after PIG seems to be linked to mechanical and geometrical alterations. In a second phase of the research we used our cotton fabric model to create a mathematic solution for PIG with no residual defects. The solution was applied in 9 men, who had sufficient penile rigidity to penetrate the partner. They underwent fascia lata patch corporoplasty using the new developed technic (iPad app - iGrafter). The pre-operative 5-itens version of the International Index of Erectile Function (IIEF5) was apply and repeated at the end of follow-up. After a mean of 16 months of follow-up no significant complication was noted. Complete straightening of the penis was achieved in 100% of patients. The median increase on the short side of the penis was 3 cm and mean graft area of 12.4cm2. At the end of the follow 33% of patients developed recurrent deformity. One patient (11%) presented an intense fibrosis in corpora cavernosa and severe ED. The mean postoperative IIEF-5 was 19.4 with no statistical difference from the preoperative (20.4). At the end of follow up all 9 patients were able to have a sexual intercourse, 2 with and 7 without pharmacological aid. Overall 89% of the patients were satisfied with the surgical result. At the end the surgical correction of penile curvature, by using the iGrafter, seems to be efficient and safe for penile rectification without residual deformities, using minimum graft area. More research is needed to prove these findings.