107 Archivio Italiano di Urologia e Andrologia 2021; 93, 1 ORIGINAL PAPER No conflict of interest declared. DOI: 10.4081/aiua.2021.1.107 INTRODUCTION Peyronie’s disease (PD) is a benign condition causing penile deformities, shortening, loss of penile flexibility and sexual dysfunctions (1). The diagnoses are increas- ing in number, even in the younger population, because of the increased knowledge about the topic (2). Surgical treatment remains the gold standard and it includes penis plication, grafting, and placement of inflatable prosthesis with the aim to restore coital functions (3). Buccal mucosa grafts (BMG) provided excellent short- term results, suggested by the early recovery of sponta- neous erections and the prevention of late shrinkage, which is the main cause of graft failure. It also seems to be safe and reproducible, thus representing a valuable treatment option for PD. Clinical series are limited yet but functional and cosmetics results are very promising (4). We analyzed our surgical results with the BMG tech- nique applied to 27 patients focusing on the ultrasono- graphic follow-up and clinical data. METHODS From our surgical data base, we evaluated 27 consecutive cases treated with a plaque incision and BMG to correct the secondary penile curvature due to PD. Clinical, post- surgical and ultrasound follow up data were evaluated. All patients were no responders to medical treatment or previous surgical procedures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history and penile dynamic ultrasound (PGE1-induced erection) features were collected (5, 6). The surgical procedures were done previous penile degloving and using a relaxing incision (double Y or H shaped) at the point of maximum curvature on the penis. The albuginea defects were covered using BMG grafting Introduction: Plaque incision and grafting represent the best surgical approach to the Peyronie’s Disease (PD). The grafting procedures must be restricted to patients with normal preoperative status, exces- sive curvature and/or deformities. However, the ideal graft has not been identified yet. Buccal mucosa grafts (BMG) provided excellent short-term results, ensuring the fast return of sponta- neous erections and preventing shrinkage, which is the main cause of graft failure. Another fearsome surgical complication is de novo erectile dysfunction (ED). We report our results with BMG focusing on the analysis of ultrasonographic and clinical data demonstrating buccal mucosa as determinant fac- tor that allow to avoid complications. Materials and methods: From 2013 to 2019 we performed at our Urology Unit 27 corporoplasties with BMG to correct com- plex penile curvature due to PD. Clinical, post-surgical and ultrasound follow up data were evaluated. All patients were no responders to medical treatment or previous surgical proce- dures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history and penile dynamic ultrasound (PGE1-induced erection) were collected. The time of spontaneous erection resumption was recorded for each patient. To improve blood supply to the graft, a low-dose PDE5-i was prescribed for all patients for a period of two months, starting immediately after discharge. Check-ups were scheduled every 3 months, starting from 1 month after sur- gery. In each visit, patients underwent a penile ultrasound evaluation of graft features. After 6 and 12 months, all patients underwent a penile dynamic ultrasound for Erection Hardness Score determination, then standard ultrasound and clinical evaluation yearly. Our analyses were focused on BMG as a major determinant of the surgical success. Results: Mean age of 27 patients was 57 years (42-71) with a maximum follow up time of 72 months and minimum of 3. Site of penile curvature was dorsal in 18 (67%) patients, ventral in 2 (7%), complex in 7 (26%). The degree of the curvature was < 60° in 11 (41%) patients, > 60° in 16 (59%). Straightening of penis was reached in 100% of cases. Penile shortening resulted in 7.4% (2/27). De novo ED appeared in 2/27 cases with a post-operative rate of PDE5i users increasing from 12 to 14 patients (45% vs 52%). Ultrasound aspects of BMG, recorded at every follow up visit, results in a hypoechoic plaque with an iperechoic rim that become isoechoic over the time in all cases. No case of scars or seroma was registered. Small intra-graft cystic lesions were highlighted in 3 cases (11%). Conclusions: BMG may represent a good choice in grafts pro- Buccal mucosa graft in surgical management of Peyronie’s disease: Ultrasound features and clinical outcomes Summary Andrea Fabiani 1 , Fabrizio Fioretti 1 , Maria Pia Pavia 2 , Luca Lepri 1 , Emanuele Principi 1 , Lucilla Servi 1 1 Urology Unit, Surgical Department, ASUR Marche Area Vasta 3, Macerata, Italy; 2 Resident, Division of Urology, Marche Polythecnic University, Ancona, Italy. PRESENTED AT THE SIEUN CONGRESS ANCONA 30 NOVEMBER - 1 DECEMBER 2020 cedures for PD surgical management. The functional results obtained by BMG procedures were related to the good anatomical characteristics of the patch and were highlighted in our series by use of penile ultrasound, dur- ing the follow up period. KEY WORDS: Peyronie’s disease; Buccal mucosa; Ultrasound; Graft; Erectile dysfunction. Submitted 13 January 2021; Accepted 27 January 2021