(188) Horizontal Plication and Reduction Corporoplasty for Penile Girth Discrepancy (Christmas Tree Deformity)

Abstract

Abstract Introduction We present a case of severe Peyronie's Disease, described as the “Christmas tree deformity” due to its crescendo shaped proximal girth discrepancy. This very rare deformity and proposed surgical correction technique have only been described in the literature once beforehand. Objective To depict the surgical correction of the severe penile girth discrepancy in video format. Methods At the start of the case, artificial erection was performed, revealing significant girth discrepancy. The proximal base of the shaft measured 21.5 cm, mid shaft 18.5 cm, and distal shaft 12 cm (Image 1). A circumcising incision was made and a plane along Buck’s fascia developed. Using careful blunt and sharp dissection, left and right neurovascular bundles were carefully elevated and gently lifted to the midline to allow for plication suture placement laterally. An artificial erection was again created, revealing significant asymmetry with 9.5cm girth discrepancy between proximal and distal shaft. Plication sutures of 1-0 Ethibond were placed using a “1+1=2” dot horizontal plication pattern, starting at the base and progressing to mid shaft on both the left and right sides. Plication sutures were placed systematically until symmetric girth was confirmed using artificial erection. A TachoSil graft was then placed along the shaft to decrease likelihood patient would feel the numerous Ethibond sutures below and also improve hemostasis. Dartos fascia was then closed with a Vicryl suture and the circumcising incision closed in a running subcuticular fashion. Again, artificial erection showed drastic improvement in penile girth magnitude and symmetry. A penile block was performed and the penis was wrapped in Kerlix gauze and coban. Results The patient was discharged on the same-day of surgery with oral pain medications. He was seen back in follow-up at 8 weeks postoperatively at which time he endorsed an uneventful recovery and that he was once again able to have penetrative intercourse with his partner. Conclusions We are proud to report on the second known case of horizontal plication and reduction corporoplasty for correction of severe penile girth discrepancy, “Christmas tree deformity.” Despite a lack of available literature on the deformity and surgical technique, we believe it is a safe and effective treatment option for patients with this rare form of Peyronie's. Disclosure No.