324 An Initial Description of Adult Men With Progression Of Chordee To A Fibrotic Disorder Of The Tunica Albuginea

Abstract

Congenital curvature from chordee without hypospadias involves excessive tunical elasticity, whereas Peyronie's disease (PD) involves acquired tunica albuginea fibrosis. We describe a subpopulation of men with congenital curvature from chordee who experienced curvature progression in adulthood. Retrospective review of all patients (>18 years of age) with chordee without hypospadias presenting to our center from 1/2015-7/2016 for evaluation of worsening curvature. Ten patients were evaluated (mean age 34.0 years, SD 13.7), most commonly presenting with worsening deformity causing cosmetic distress as well as compromised ability to engage in intercourse, and/or partner discomfort. Patients described a mean subjective curvature of 51.5° (SD 21.1°), pain (30%), hinge effect (10%), shortening (20%), and poor erection quality (10%). There were no reported traumatic events preceding worsening curvature. Reduced shaft elasticity was identified in 70% with palpable areas of fibrosis including septal cord or tunical thickening. Stretched penile length was 11.9 cm (SD 1.9). Via in-office artificial erection, 60% had a maximum rigidity score of 8-9/10 with 55.5° mean curvature (SD 17.9°, range 30.0-90.0°). Ventral curvature was present in 70%, 40% had narrowing, and there was no noted hinge, calcification or corporal fibrosis. Seven patients elected to undergo tunica albuginea plication (TAP). All 7 patients noted satisfaction with the result, were functionally straight (<15° residual curvature), and had no change in erectile function. Pain resolved following TAP in the two patients that initially presented with pain. The median decrease in stretched penile length at initial postoperative visit was 0.75 cm (range 1.0-2.0 cm), however, no patients reported significant penile shortening. Traction therapy was recommended to restore preoperative penile length. One patient with erectile dysfunction (57 years old) underwent placement of a 3 piece inflatable penile prosthesis and manual modeling, with straight, satisfactory erections postoperatively.