Congenital Penile Deviation Research Articles

Corporoplasty in Peyronie’s Disease: a Literature Review

Corporoplasty is urological correction surgery for penile deviation that causes copulatory dysfunction or aesthetic discomfort. Penile deviation can be congenital or acquired (Peyronie’s disease, penile fracture). Congenital penile deviation is relatively rare and manifests in the curvature of erect penis ventrally and/or laterally, in most cases. According to many studies, patients with curvatures of 30° or more eventually seek surgical treatment. Congenital curvature may be mistaken for Peyronie’s disease for similar manifestations that, however, differ in aetiology and pathophysiology. Excisional, incisional corporoplasty or plication are commonly engaged to treat congenital curvatures, in various techniques and modifications. Augmentation transplantation (grafting) and penile prosthesis implantation with variant deviation treatment options are the usual practice in Peyronie’s disease. Unequivocal judgment of pros and cons in any particular technique is nevertheless implausible to make. This article aims to review current trends, protocols and their relative advantages in corporoplasty.

Alei II Minimally Invasive Technique for the Correction of Penile Curvature Without Circumcision

In 2012, we developed a new surgical technique for the correction of congenital and acquired penile curvature without circumcision called “track” corporoplasty or Alei II technique. We report the results of this technique. The procedure can be performed under local anaesthesia. For the penile ventral curvature repair an infrapubic transverse dorsal incision is made to correct a ventral curvature or when removing or cutting the plaque in Peyronie’s disease. Colles’ fascia is opened with forceps and Colle’s space is expanded to separate the tissue planes. Then, a single 0 non-absorbable synthetic multifilament suture is placed in order to perform a special placation on two parallel lines and therefore called “track”. Mean age was 54 years for patients with Peyronie’s disease and 45 years for patients with congenital penile deviation. The mean follow-up period was 36 months. No major complications, no circumcision, overall satisfaction 98%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 2%.

Alei II Technique: Minimally Invasive Technique for the Correction of Penile Curvature without Circumcision

Objective: We describe a new surgical technique for the treatment of penile curvature. In 2012, we developed a new surgical technique for the correction of congenital and acquired penile curvature without circumcision called “track” corporoplasty or Alei II technique Design and Method: For the penile ventral curvature repair an infrapubic transverse dorsal incision is made to correct a ventral curvature or when removing or cutting the plaque in Peyronie’s disease A single 0 non-absorbable synthetic multifilament suture is placed in order to perform a special placation on two parallel lines and therefore called “track”. Laterally to the corporoplasty described, two corporoplasties should be performed along the line that goes from the dorsal neurovascular bundle to the lateral end of the corpus cavernosus at 30° and 60° on the penile sagittal plane. The two corporoplasties should measure 50% at 30° and 25% at 60. Results: Mean age was 43 years for patients with Peyronie’s disease and 31 years for patients with congenital penile deviation. The mean follow-up period was 36 months. No major complications, no circumcision, overall satisfaction 98%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 2%. Conclusions: This original technique is associated with low morbidity, low recurrence rate and excellent aesthetic results.

Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment

Penile corporoplasty is a well-established treatment method of congenital penile deviation (CPD). Anatomical results are good with only slight differences between surgical procedures used. The disease however has huge influence on young male quality of life. This issue is not well analyzed in the literature. The aim of the study was to evaluate quality of life of the patients affected with CPD before and after the surgical treatment Study population consisted of 107 patients with CPD referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function. Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method. CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being.

Traitements médicaux et chirurgicaux des courbures de verge congénitales et acquises : revue de la littérature

The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.

Tunica Albuginea Underlap—A New Modification of the Nesbit Procedure: Description of the Technique and Preliminary Results

We describe a new surgical technique for the treatment of penile curvature that combines features of the Nesbit procedure with features of tunical plication. U-shaped flaps of tunica albuginea are freed from the corpus cavernosum. The flaps are brought under the remaining tunica albuginea and are fixated with single absorbable sutures. As the defects of the tunica are sealed tightly and with high tensile strength by double layers of tunica albuginea, correction of the abnormal curvature is achieved. To present our experience with a new surgical technique for the treatment of penile curvature. Between 2008 and 2011, 50 patients underwent the underlap technique because of Peyronie's disease (37) or congenital penile deviation (13) in a single center. Preoperative and postoperative evaluation included the Erection Hardness Score (EHS) and the Symptom Score for Induratio penis plastica (IPP-SSC), a symptom score for penile deviation that was based on a consensus of regional andrologists. Clinical data concerning the early postoperative outcome were analyzed retrospectively using standardized items. Mean age ± standard deviation was 59.7 ± 8.4 years for patients with Peyronie's disease and 34.1 ± 7.8 years for patients with congenital penile deviation. The mean follow-up period was 27 months. The major complication rate was 4%, overall satisfaction 86%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 6%. The mean difference of preoperative and postoperative IPP-SSC was 8.1 (95% confidence interval [CI] 7.24 to 8.96). The mean difference of preoperative and postoperative EHC was -0.03 (95% CI -0.16 to 0.09). Preliminary results obtained with the underlap technique showed promising outcome with minimal morbidity. The new technique might have three main advantages: more flexible intraoperative correctability of the curvature, tighter sealing of the tunical defects, and greater tensile strength of the plications.

Superficial tunica albuginea excision, using geometric principles, for the correction of congenital penile curvature

Study Type--Therapy (practise pattern survey) Level of Evidence 3b. What's known on the subject? and What does the study add? Congenital penile deviation has become a relatively frequent finding due to a greater awareness of the problem among patients and physicians. Since the first surgical correction for congenital penile curvature was performed, many modifications have been implemented to overcome the disadvantages of the standard procedure and to improve functional results. Among the possible side effects of the original technique are postoperative erectile dysfunction, the development of painful nodules at the suture sites ('dog ears'), alteration of cutaneous sensibility and significant penile shortening. This study presents a novel approach for the correction of congenital penile curvature. We modified the conventional Nesbit technique by applying superficial tunica albuginea excisions, according to the geometric principles of the Egydio technique. • To report our experience with a new technique for the correction of congenital penile curvature based on geometric principles. • Between January 2006 and March 2011, 211 men with congenital penile curvature underwent our modified Nesbit technique. • The technique consists of an objectivation of the degree of curvature and distribution of the bending force by multiple, small, superficial, elliptical excisions of the tunica albuginea. • The overall success rate was 99.1%. • A residual curvature of less than 20° was reported in 5% (n = 11) of the cases; none of these patients opted for further surgical correction. • Residual curvature of up to 30° was observed in 0.9% (n = 2); these patients underwent a reoperation. • Acquiring or regaining the ability to perform sexual intercourse brought major relief and high rates of satisfaction and self-esteem. • No recurrence of a ventral curvature occurred. • Our modified Nesbit technique, consisting of superficial tunica albuginea excision according to the geometric principles of the Egydio technique, leads to rapid and excellent results due to an objectivation of the curvature. • It is a safe and valid alternative for the treatment of congenital ventral or ventro-lateral penile deviation.

The Psychosocial Impact of Penile Reconstructive Surgery for Congenital Penile Deviation

A variety of surgical techniques to correct congenital penile deviation (CPD) have been described. Although surgical outcomes have been reported, the impact of this treatment on sexual relationship, confidence, self-esteem, and sexual function has never been established. To assess the impact of surgical treatment for CPD on sexual relationship, confidence, self-esteem, and sexual function, employing validated instruments. The Self-Esteem and Relationship (SEAR) and International Index of Erectile Function (IIEF) questionnaires. Prospective, longitudinal, uncontrolled study of 32 men undergoing penile reconstructive surgery for CPD. Assessment of change in sexual relationship, confidence, self-esteem, and sexual function scores. Twenty (37.5%) patients had ventral and 12 (62.5%) had lateral curvature, mean magnitude was 37 +/- 12 degrees . Significant improvement in SEAR domains scores was observed in sexual relationship (82 vs. 40, P < 0.01), overall relationship (86 vs. 62, P < 0.01), and confidence (88 vs. 58, P < 0.001). While mean IIEF erectile function domain score was unchanged: 24 +/- 3.6 and 25 +/- 2.5, before and after surgery, respectively (P = 0.85), significant improvements were observed in the libido (8 vs. 5, P = 0.02) and satisfaction (22 vs. 15, P < 0.01) domains of the IIEF. Predictors of improvement in SEAR and IIEF scores were perceived complete straightening and penile length preservation. Penile reconstructive surgery for CPD is associated with significant improvements in overall relationship, sexual relationship, confidence, libido, and satisfaction, as reflected by higher scores in three of the four domains of the SEAR questionnaire and improvements in two of the four domains of the IIEF.

THE IMPACT OF RECONSTRUCTIVE SURGERY FOR CONGENITAL PENILE DEVIATION ON PSYCHOSEXUAL FACTORS

You have accessJournal of Urology1 Apr 2008THE IMPACT OF RECONSTRUCTIVE SURGERY FOR CONGENITAL PENILE DEVIATION ON PSYCHOSEXUAL FACTORS Omar Nabulsi, Raanan Tal, Christian Nelson, and John P Mulhall Omar NabulsiOmar Nabulsi More articles by this author , Raanan TalRaanan Tal More articles by this author , Christian NelsonChristian Nelson More articles by this author , and John P MulhallJohn P Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61189-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "THE IMPACT OF RECONSTRUCTIVE SURGERY FOR CONGENITAL PENILE DEVIATION ON PSYCHOSEXUAL FACTORS." The Journal of Urology, 179(4S), p. 406 © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byMorgentaler A (2018) Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical ConsiderationsJournal of Urology, VOL. 189, NO. 1S, (S26-S33), Online publication date: 1-Jan-2013.Morgentaler A (2018) Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical ConsiderationsJournal of Urology, VOL. 181, NO. 3, (972-979), Online publication date: 1-Mar-2009. Volume 179Issue 4SApril 2008Page: 406 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Omar Nabulsi More articles by this author Raanan Tal More articles by this author Christian Nelson More articles by this author John P Mulhall More articles by this author Expand All Advertisement PDF downloadLoading ...

Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature

To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction (ED). Fifty-four patients (mean age 24 years, range 20-31 years) whose congenital penile deviation due to physiological curvature was>or=25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde's parameters (contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability). All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.

Long‐Term Results of Autologous Venous Grafts for Penile Morphological Reconstruction

In order to evaluate the long-term results of autologous venous grafts, we present an overview of patients who underwent a procedure utilizing a venous patch from the deep dorsal vein with or without combination of the cavernosal vein in treating penile deformity. From March 1995 to March 2005, a total of 85 consecutive patients with Peyronie disease or congenital penile deviation underwent venous grafting. Tunical corporotomy was covered using transplanted venous wall sutured microscopically to collagen bundles of the inner circular and outer longitudinal layer of the tunica albuginea. The vein was sutured with the serosal side outward, after it had been detubularized, properly constructed, and spliced together. In this cohort, 48 patients with Peyronie disease and 37 with congenital penile deviation were respectively categorized as belonging to the Peyronie and congenital groups. All patients were evaluated preoperatively and postoperatively with the International Index of Erectile Function (IIEF-5) scoring, angle measurement of erectile penis, satisfaction with the penile shape, and a cavernosogram which was further available for 15 patients. Histological confirmation in 5 cases was followed up for up to 10 years. The mean angle improvement was 44.8 +/- 3.6 degrees for the Peyronie group and 37.6 +/- 3.8 degrees for the congenital group. A satisfactory penile shape was achieved in 77 (90.6%) patients, although 8 men (9.4%) complained of mild deviation of the penis (<15 degrees). Erectile function was good in 81 patients, although 6 of them had to use oral sildenafil/tadalafil postoperatively. Overall, they had a mean preoperative IIEF-5 score of 19.7 +/- 2.8, which increased to a mean postoperative score of 21.6 +/- 2.2. The cavernosograms consistently disclosed a good penile shape. The histological confirmation showed that the donor vein retained its histological character despite the fact that perfect coalescence and lining up with the tunica albuginea were noted. The autologous vein appears to be an acceptable graft material, and the transplanted vein may have a modeling action rather than a scaffolding role in venous patch surgery on the penile tunica albuginea. Careful microsurgical manipulation is required to achieve a satisfactory, sustainable outcome.

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective.

To investigate retrospectively the long-term functional results and quality of life of patients undergoing the Essed-Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire. Between 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow-up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid. Of the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients' partners were satisfied with the outcome. The tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed-Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.

Tunikaplikatur mit horizontalen Inzisionen der Tunica albuginea in der Behandlung kongenitaler Penisdeviationen

The Schroeder-Essed plication procedure is a standard technique for the correction of penile curvature. In a retrospective analysis we compared functional results and quality of life of the original technique with inverted sutures as described by Schroeder-Essed and our slight modification consisting of horizontal incisions into the tunica albuginea. A total of 26 patients with congenital penile deviation were treated, 11 by the original Schroeder-Essed plication with inverted sutures and 15 using the described modification. In the modified technique, horizontal and parallel incisions 4 mm - 6 mm apart and about 8 mm - 10 mm long were made through the tunica albuginea. The outer edges of the incisions were then approximated with permanent inverted sutures (Gore-Tex(R) 3-0). Mean age was 21.6 years in the first group and 23.2 years in the second group. The preoperative penile deviation angle was > 25 degrees in all patients without differention between the two groups. All patients in both groups reported improvement in their quality of life and full ability to engage in sexual intercourse. A total of 9 patients (88 %) in the first group and 14 patients (93 %) in the second group were satisfied with the cosmetic result, although 10 patients (91 %) in the first and 13 patients (87 %) in the second group complained of penile shortening. Recurrence of deviation was only observed in 2-males in the first group (18 %). Our results indicate that this simple modification of the Schroeder-Essed plication offers good functional and cosmetic results. Most patients were satisfied with the penile angle correction results.

Polytetrafluoroethylene Versus Polypropylene Sutures for Essed-schroeder Tunical Plication

Essed-Schroeder plication is an established operative technique to correct congenital and acquired penile deviation. However, a third of all patients complain about discomfort from the suture material used. We prospectively evaluated patient satisfaction and quality of life after modified Essed-Schroeder plication by comparing 2 suture materials. Between 1998 and 2001, 88 patients underwent surgical correction of penile deviation at our hospital. Mean patient age was 40 years (range 18 to 71) and mean followup was 30 months. Preoperatively penile curvature was greater than 20 degrees in all patients. A standardized questionnaire was sent to all patients. A total of 55 patients, including 30 with Peyronie's disease (PD) and 25 with congenital penile deviation (CPD), were available for evaluation and had complete followup. In 25 of these patients (12 with PD and 13 with CPD) nonabsorbable polypropylene (PP) sutures were used for plication, whereas in the other 30 (18 with PD and 12 with CPD) nonabsorbable polytetrafluoroethylene (PT) sutures were used. In the PP group 22 of the 25 patients (88%) could notice the sutures (11 with PD and 11 with CPD), 10 had discomfort (6 with PD and 4 with CPD) and 3 had pain during penile erection (2 with PD and 1 with CPD). In the PT group 15 of the 30 patients (50%) could notice the sutures (10 with PD and 5 with CPD), 3 had discomfort (1 with PD and 2 with CPD) and 1 with PD had painful erections. Three patients had recurrent deviation, of whom 2 and 1 underwent plication with PP and PT, respectively. These results indicate the PT is the more superior suture material with regard to postoperative patient discomfort after Essed-Schroeder correction of penile deviation. Nonabsorbable PT sutures do not impair the efficacy of the modified Essed-Schroeder plication technique and the success rate is not related to the underlying pathological condition.

Slightly modified technique of the original essed plication procedure for congenital penile deviation

The Schroeder-Essed plication procedure is a standard technique for the correction of penile curvature. In a retrospective analysis we compared functional results and quality of life (LQ) of the original technique with inverted sutures as described by Schroeder-Essed and our slight modification consisting of horizontal incisions into the tunica albuginea. Twenty-six patients with congenital penis deviation were treated for penile deviation by the original Schroeder-Essed plication with inverted sutures (11 patients) and by the described modification (15 patients). In case of modified technique, horizontal and parallel incisions 4 mm to 6 mm apart and about 8 mm - 10 mm long were made through the tunica albuginea. The outer edges of the incisions were then approximated with permanent inverted sutures (Gore-Tex 3-0). Mean age was 21.6 years in the first group and 23.2 years in the second group. Average follow-up was 28 months and 13 months, respectively. The preoperative penile deviation angle was > 25 degrees in all patients without difference between the 2 groups. All patients in both groups reported an improvement in their quality of life and full ability to engage in sexual intercourse. Nine patients (88%) in the first group and 14 patients (93%) in the second group were satisfied with the cosmetic result. In contrast, 10 patients (91%) of the first and 13 patients (87%) of the second group complained of penile shorting. Recurrence of deviation was only noticed in 2 males in the first group (18%). Our results indicate that this simple modification of the Schroeder-Essed plication offers good functional and cosmetic results. Most patients were satisfied with the penile angle correction results.

Blood Gas Changes in the Corpora Cavernosa: Metabolic and Histomorphometric Implications in the Patient with Erectile Dysfunction

We evaluated corpora cavernosa metabolism in flaccidity and in erection, analyzing some blood gas analytical parameters and comparing them by histomorphometric examination to find a direct relation between biochemical-metabolic parameters and histological data. We selected 33 patients with erectile dysfunction and divided them into 2 groups, including 1-those with congenital penile deviation who were responders to prostaglandin E1, and 2-those with severe organic erectile dysfunction who were not responders to prostaglandin E1. We evaluated O(2) and CO(2) pressure, pH and O(2) saturation in blood samples. We then made a histomorphometric study of cavernous tissue. We obtained specimens by cavernous biopsies and calculated O(2) and CO(2) exchange, the Haldane effect and the respiratory quotient into the corpora cavernosa. All data were evaluated by statistical analysis. Mean O(2) arterial pressure and saturation +/- SD were lower in group 2 than in group 1 (74.85 +/- 8.78 versus 96.43 +/- 14.87 and 94.98 +/- 1.4 versus 97.35 +/- 0.83, respectively). Mean CO(2) arterial pressure was 35.59 +/- 4.78 group 1 versus 38.8 +/- 2.71 in group 2 with borderline statistical significance. The Haldane effect was superior in flaccidity than in erection because of the influence of arterial-venous O(2) difference and the respiratory quotient, which was also an inverse ratio. Cavernous histomorphometry showed that in group 1 smooth muscle was a mean of 38.8 +/- 8.94% of cavernous tissue versus 24.9% in group 2. Our study shows that starting with blood gas analytical data we can completely study the metabolism of the corpora cavernosa and its relationships to erectile dysfunction. Cavernous histomorphometry can suggest the presence of smooth muscle into cavernous tissue, whereas our mathematical elaboration allowed us to evaluate all data in a more complete manner.

Comparison between a slightly modified and the original essed plication procedure for congenital penile deviation

Comparison between a slightly modified and the original essed plication procedure for congenital penile deviation

CORPOROPLASTY USING TUNICA ALBUGINEA FREE GRAFTS FOR PENILE CURVATURE: SURGICAL TECHNIQUE AND LONG-TERM RESULTS

A Nesbit or plication procedure for correcting penile deformities is associated with penile shortening, especially in patients with excessive curvature and/or rotation. On the other hand, grafting procedures are associated with poor postoperative results due to graft shrinkage and veno-occlusive dysfunction. To minimize penile shortening and preserve potency we describe a new surgical technique combining the Nesbit procedure with tunica albuginea free grafting. Long-term functional results and patient satisfaction are reported. We treated 17 potent patients with a mean age plus or minus standard deviation of 46.1 +/- 14.5 years, including 4 with congenital penile deviation and 13 with stabilized Peyronie's disease. Opposite the point of maximal curvature a typical Nesbit procedure was performed. The excised tunica albuginea segment consequently served as a free graft. A symmetrical incision was made at the opposite site and the preserved elliptical tunica albuginea graft was placed in the defect. Further elliptical excisions and grafting followed as needed to correct the deformity. At a mean followup of 39.5 +/- 13.7 months (range 18 to 62) all patients reported penile straightening and functional erection, while ultrasonography of the corpora cavernosa revealed no changes in graft ultrastructure. There was penile shortening in 8 patients (47%) but only 2 (11.7%) considered it significant. All patients with a minimum 2-year followup were positive in regard to recommending the operation to others or repeating it if necessary. The newly described technique may be considered as a treatment option in patients with excessive penile curvature since shortening of the penile shaft is eliminated by 50% compared with the result of the Nesbit procedure. Tunica albuginea seems to be an appropriate grafting material since it prevents postoperative corporeal veno-occlusive dysfunction.

Correction of Complex Penile Deformities by Modified Nesbit Procedure Asymmetric Tunica albuginea Excision

Purpose: Penile angulation combined with penile torsion is an uncommon finding in case of congenital or acquired penile curvature. We describe our technique for treatment of complex penile curvature by the excision of asymmetric ellipses of tunica albuginea.Materials and Methods: During the last 4 years, 4 patients with complex penile curvature underwent surgical correction by the excision of asymmetric ellipses of tunica albuginea. 3 patients had Peyronie’s disease and 1 had congenital penile deviation. They ranged in age from 27 to 63 years.Results: Convalescence was uneventful with good cosmetic correction of the penile torsion and lateral curvature in all patients. 1 patient reported shortening of the penis of about 2 cm, postoperatively. 2 patients reported decreased penile sensation, which resolved after 3 months. Erectile failure did not occur postoperatively in any case.Conclusions: During the last years many Authors have modified the original surgical procedure in an attempt to correct penile deformity. Unfortunately there are very few reports about correction of penile deformities combined with penile torsion. Our modified Nesbit surgical technique for complex deformities differs from the others with regard to the shape of the incision. In this manner, by shortening the longer corporeal body and creating a torque on the penis, it is possible to correct both problems: penile angulation and torsion. The technique is simple, bloodless, safe and reliable. In our experience good cosmetic and functional results have been achieved without complicated surgical interventions.

Results of Surgical Treatment for Abnormal Penile Curvature: Peyronie's Disease and Congenital Deviation by Modified Nesbit Plication (Tunical Shaving and Plication)

We report a modification of the Nesbit plication with partial thickness shaving instead of conventional excision of a wedge of tunica albuginea. The technique minimizes intraoperative bleeding, obviates cavernous tissue damage and improves adhesion of plicated tunical layers. Between September 1988 and September 1994, 32 patients underwent modified plication repair of chordee secondary to Peyronie's disease (26) or congenital penile deviation (6). The results were evaluated in the spring of 1996. Mean age plus or minus standard deviation was 55 +/- 8.8 years for patients with Peyronie's disease and 27 +/- 6.85 years for those with congenital penile deviation. Mean duration of Peyronie's disease was 22 +/- 9 months. Eight patients complained of erectile dysfunction and penile curvature. Plication for congenital deviation (6 patients) resulted in 100% satisfaction with the surgical result. Of the 26 men with Peyronie's disease 19 (78%) reported a good to excellent outcome. With prolonged followup (1 to 5 years) 7 patients had recurrent curvature due to progression of disease, including 5 with mild curvature who were able to have intercourse, in contrast with 2 who had severe early recurrence of deformity (more than 30 degrees) within 1 year postoperatively and underwent a second modified plication with good clinical outcome. Six of 32 patients with peyronie's disease were unable to resume satisfactory coitus with a postoperative straight penis. All 6 patients had concomitant poor erections preoperatively as shown by nocturnal peniletumescence and rigidity testing and 5 of them resumed regular intercourse with intracavernous pharmacotherapy. Long-term results of this modified plication demonstrate excellent clinical outcome with minimal morbidity.