Inclusion cyst and graft contraction in Tutoplast human cadeveric pericardium following Peyronie's grafting: a previously unreported complication

International Journal of Impotence Research (2005) 17, 550552

& 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00www.nature.com/ijirCase ReportInclusion cyst and graft contraction in Tutoplast human cadeveric

pericardium following Peyronies grafting: a previously

unreported complicationDD Thiel1*, GA Broderick1 and KJ Wu11Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida, USATutoplast human cadaveric pericardium has been utilized safely and successfully in numerous

series of tunica albuginea grafting for Peyronies curvature without reported rejection, cyst

formation, or foreign body reaction. We describe a previously unreported complication of inclusion

cyst formation and graft contraction in a 40-year-old white male following Tutoplast human

cadaveric pericardial graft surgical correction of Peyronies curvature. The complication was

successfully treated with surgical graft excision and replacement with autologous temporalis fascia.

International Journal of Impotence Research (2005) 17, 550552. doi:10.1038/sj.ijir.3901347;

published online 2 June 2005Keywords: Peyronies disease; tissue grafts; penile induration; penisIntroductionTutoplast human cadaveric pericardium has been

utilized safely and successfully in numerous surgical series of tunica albuginea grafting to correct

Peyronies penile curvature.14 There have been no

reported cases of tissue rejection, infection, or

reactive cyst formation in any of these series. We

describe a previously unreported complication and

subsequent surgical therapy of cyst formation and

graft contraction in a Tutoplast human cadaveric

pericardial graft following surgical correction of

Peyronies penile curvature.Case reportA 40-year-old white male presented to our clinic

with a 1-year history of 45 degree painless leftward

penile curvature limiting sexual penetration. The

patient denied any related penile trauma. Curvature

failed to respond to several months of vitamin E and

Potaba therapy. Past medical history was significant

for 1 year of diet controlled noninsulin-dependent

diabetes without other endocrine abnormalities.Physical examination revealed a slightly overweight male with left lateral induration of the tunica

albuginea but no palpable nodule. A penile blood

flow study with 10 mg prostaglandin followed by

self-stimulation revealed a 45 degree leftward penile

curvature with tunica albuginea thickening but no

calcification. Peak systolic velocities were 57.5 and56.1 cm/s with resistive indices over 100 (normal

vascular erectile dynamics).After 18 months of stable curvature confirmed

by interval examination of home photographs, the

patient was taken to the operating room for tunica

albuginea incision and graft placement. Operative

technique is similar to that described elsewhere.14

Of note the patient received intravenously 1...