The Impact of Peyronie’s Disease on Male Sexual Function and Recent Advances in its Management

Recent data have demonstrated a positive impact of in vitro applied mechanical pressure, strain and shear stress on proliferation, differentiation and de novo extracellular matrix synthesis of mature fibroblasts .Therefore these techniques are used for tissue engineering of viable fibrous tissues, as e.g. ligaments and tendons in orthopedic and trauma surgery. The same principles seem to be feasible for the in vitro construction of fascia tissue for hernial repair in abdominal surgery and of tunica albuginea for penile surgery in urology. So far, fibroblast and myofibroblast cell cultures have only been used to investigate the pathophysiology of Peyronie’s disease .In these studies e.g. fibroblast cell proliferation, an increased production of collagen, mainly type I and III, and basic fibroblast growth factor (bFGF) have been taken as a cell culture model for plaque formation. Keeping this in mind, the use of fascia or skin fibroblasts in tissue engineered grafts for tunica albuginea replacement, as suggested in this article, might also bear some risks and unknown potentials in respect to fibrosis, resulting in graft shrinkage and recurrent penile deviation. It is not known how reseeded fibroblasts will behave after implantation and whether they will counteract or enhance postoperative fibrosis and shrinkage of the graft area in vivo by any of the above mentioned mechanisms. These issues have to be addressed and clarified by future in vitro and preferably in vivo experimental work. (Kessler et al., 2001).On the other hand, an implanted acellular matrix will always be repopulated with blood cells first after the operation procedure. This heamatoma-like infiltrated graft will then be reorganized by regular wound healing cascades involving a high risk of uncontrolled fibrosis in this granulation tissue .This is considered to be different in tissue engineered grafts. Here viable and functional cells, in this case fibroblasts, are already in situ forming a tissue-like cell compound which can more easily be integrated into the surrounding local tissue after neovascularization. The corpus cavernosum then provides an optimal underlying implantation site which facilitates a close contact of the graft to the circulating blood and by this will allow a fast and effective neovascularization of the cell seeded graft. (Ahuja et al., 1999).