Use of porcine small intestinal submucosal graft in the surgical management of tunical deficiencies with penile prosthetic surgery.

ABSTRACT

OBJECTIVES: To report the use of a new acellular xenographic porcine jejunal submucosal graft as a closure material for tunica albuginea deficiencies (distal erosion, attenuation) after penile prosthesis insertion. METHODS: Seventeen patients with at least a 36-month history of having an indwelling three-piece inflatable penile prosthesis developed tunica albuginea deficiencies. Nine patients with unilateral distal erosion of the tunica and eight with attenuation of the tunica underwent penile prosthesis revisionary surgery and tunical reconstruction using lyophilized small intestinal submucosa (Surgisis). The reconstructive techniques used a suprapubic and subcoronal incisional approach and a new three-piece inflatable prosthesis. RESULTS: Reconstructive surgical correction of the tunical defect was achieved in all 17 patients. At a mean follow-up of 21 months (range 6 to 34), no patient had had separation of the graft from the tunica or recurrence of the deficiency. All patients had a satisfactorily functioning prosthesis. Infection, pain, bulging, or evidence of a local inflammatory response at the graft site has not occurred. No patient required any additional surgery. CONCLUSIONS: At the initial long-term follow-up, acellular porcine jejunal submucosal grafts for coverage of tunical deficiencies with penile prosthetic surgery allow for satisfactory clinical results. The ease of surgical handling and placement, elimination of nonabsorbable synthetic grafting materials, and no associated comorbidities from graft harvesting techniques, coupled with no adverse reactions, make this graft an anatomic and functional tunical substitute.