(328) Subtunical Apposition of Bioabsorbable Tissue Reinforcement Mesh Graft for Surgical Treatment of Peyronie’s Disease

Abstract Introduction Peyronie's disease affects approximately 9% of the male population and is most prevalent after the 6th decade of life. Its clinical presentation is quite variable, from mild curvatures with no impact on sexual activity, to cases with pronounced curvatures, shortening and penile deformities, with or without erectile dysfunction, which can compromise or even make sexual intercourse impossible. The treatment regimen is individualized according to the patient's clinical presentation and aligned with their expectations to achieve the best possible outcome. Objective To present a case of graft apposition with bioabsorbable polymer mesh, as a viable option for correcting accentuated curvatures in Peyronie's Disease. Methods We present the case of a 53-year-old man with a dorsal penile curvature of approximately 60 degrees during erection for 18 months, with stability for more than 6 months and with good erectile function, but with considerable difficulty in penetration during sexual intercourse. The plaque incision technique with graft placement was chosen to preserve penile size. The graft chosen was a tissue reinforcement matrix, a mesh of biocompatible synthetic polymers that are gradually absorbed by the body. The mesh has a porous structure, which allows cellular infiltration and tissue proliferation with local neovascularization. Penile degloving and dissection of the dorsal neurovascular bundle were performed. After erection induction, the apex of the curvature was identified, where a double-Y incision of the dorsal albuginea was made, promoting relaxation of the curvature and creating a space for graft placement. The graft was placed subtunically, suturing it to the tunica albuginea with absorbable monofilament suture. Results The tissue reinforcement mesh was more rigid than other conventional biological grafts, which increased intraoperative time. However, the rigidity of the mesh apparently prevents tissue retraction and early recurrence of penile curvature. The porosity of the mesh did not allow testing the correction of penile curvature at the end of the procedure through erection induction with saline solution infusion. However, despite the porosity of the material used, there was no formation of hematoma or penile edema in the immediate postoperative period. After a 5-month postoperative follow-up, the patient presented with rectification of the penile curvature and maintained good erectile function, which allowed him to return to his sexual activities satisfactorily. Conclusions Respecting the patient selection criteria for correction of penile curvatures, the apposition of a bioabsorbable tissue reinforcement matrix graft may be a good material option for the surgical treatment of patients with Peyronie's disease with accentuated curvature and good erectile function. Disclosure No