INVESTIGATIVE UROLOGY

Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model
Hafez AT, El-Assmy A, El-Hamid MA
Urology & Nephrology Centre, Mansoura University, Mansoura, Egypt
BJU Int. 2004; 94: 433-6

• Objective: To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee.
• Materials and Methods: Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 microg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome.
• Results: None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 microg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea.
• Conclusions: In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.
  
  
• Editorial Comment
  Many materials have been investigated for corporal body grafting in surgical correction of chordee and Peyronie’s disease (porcine small intestinal submucosa and tunica acellular matrix, as examples). This article evaluated the feasibility of using a commercially available fibrin glue (‘Tisseel’, Baxter Healthcare Corp., Irvine, California) for covering corporal body defects, with potential application in the surgical management of severe chordee. In rabbits, the results were excellent. Fibrin glue may be considered a suitable substance for corporal body grafting in the future.

Dr. Francisco J.B. Sampaio
Full-Professor and Chair, Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, Brazil