Collagen fleece versus porcine small intestinal submucosa grafting for Peyronie's disease: A comparative analysis

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BACKGROUND: Peyronie's disease (PD) is a fibrotic disorder affecting the tunica albuginea, leading to penile curvature and deformity, significantly impacting sexual function and quality of life. Surgical correction remains the gold standard for patients with severe curvature, yet the optimal grafting material remains undetermined. Small intestinal submucosa (SIS) and collagen fleece (CF) grafts are widely used, but their comparative efficacy is still debated. OBJECTIVES: Our aim is to compare the clinical outcomes of SIS and CF grafting techniques in penile lengthening procedures for PD, evaluating postoperative outcomes and patient satisfaction. MATERIALS AND METHODS: A retrospective cohort study was conducted, including 62 patients undergoing penile surgery with SIS (n = 31) or CF (n = 31) grafts. Preoperative variables included age, diabetes mellitus (DM) status, penile curvature, erectile function, and penile length. Primary outcomes assessed were operative time, postoperative penile length, erectile function, complication rates, and patient-reported satisfaction. All statistical analyses were conducted using IBM SPSS Statistics. RESULTS: The CF group had significantly shorter mean operative times (105±23 vs. 159±29 min, p < 0.001) and lower rates of penile hypoesthesia (12.9% vs. 45.2%, p = 0.005) and curvature recurrence (16.1% vs. 41.9%, p = 0.025). However, CF grafting was associated with higher postoperative pain (22.6% vs. 3.2%, p = 0.023). No significant differences were found in erectile function decline, penile length gain, or patient satisfaction. DISCUSSION: CF grafting offers shorter surgical time and reduced recurrence rates, whereas SIS grafting results in lower postoperative pain. Both techniques provide comparable penile length preservation and erectile function outcomes. CONCLUSION: CF and SIS grafts are effective in PD surgery, with CF reducing operative time and complications but increasing pain. Personalized graft selection is essential for optimizing surgical outcomes and patient satisfaction.

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