(318) Surgical Correction of Severe Peyronie’s Curvature Using Bovine Pericardial Graft

Abstract Introduction Peyronie’s disease is a progressive fibrotic disorder of the tunica albuginea that leads to penile curvature, deformity, and functional impairment. Severe cases, particularly those with curvature exceeding 60 degrees, often preclude penetrative intercourse and require surgical correction. While plication techniques are sufficient for mild to moderate deformities, advanced cases demand more extensive reconstruction. Tunical excision with grafting has emerged as a reliable solution in this setting. Bovine pericardial grafts are widely used because of their tensile strength, elasticity, low immunogenicity, and ease of intraoperative handling. Objective This video abstract demonstrates the surgical technique of tunical excision and grafting with bovine pericardial patch for the correction of severe dorsal penile curvature in Peyronie’s disease, emphasizing technical steps, preservation of erectile function, and strategies to minimize complications. Methods Following circumferential penile degloving, the dorsal neurovascular bundle is carefully dissected and laterally mobilized to allow safe exposure of the plaque. The fibrotic tunical segment causing the curvature is sharply excised, resulting in a defined tunical defect. A tailored bovine pericardial graft is fashioned to match the defect size and contour. Using absorbable monofilament sutures, the graft is anchored to the tunical margins under minimal tension, ensuring precise anatomic alignment and watertight closure. Intraoperative artificial erection testing is performed to confirm full correction of the deformity, stability of the penis, and graft integrity before concluding the procedure. Results In the presented case, the patient exhibited a severe 90-degree dorsal curvature that was successfully corrected with complete penile straightening. Erectile function was preserved, and there were no intraoperative complications such as bleeding, neurovascular injury, or graft instability. Postoperatively, the patient recovered without hematoma, infection, or graft rejection. Functional evaluation confirmed satisfactory rigidity and sexual performance, while cosmetic outcomes and penile length were maintained. Patient-reported outcomes demonstrated high satisfaction with both appearance and function. Conclusions Tunical excision with bovine pericardial grafting provides a safe and effective surgical option for severe Peyronie’s disease with complex curvature. By enabling direct plaque removal and anatomic restoration of the tunica albuginea, this technique achieves durable penile straightening without compromising erectile capacity. The use of bovine pericardial grafts facilitates reliable reconstruction and favorable healing. As demonstrated in this video, meticulous neurovascular bundle mobilization, careful graft sizing, and intraoperative erection testing are key to optimizing results and avoiding complications. This approach should be considered an essential tool in the surgical management of advanced Peyronie’s disease requiring grafting techniques. Disclosure No