Congenital Ventral Penile Curvature Research Articles

(167) Shaeer’s Corporal Rotation IV: Length and Girth Preserving Technique for Correction of Severe Congenital Ventral Penile Curvature

Abstract Introduction For cases with severe penile curvature, the loss in length with shortening techniques, or the loss in rigidity with incision-grafting can compromise the results, hence the advent of Shaeer’s Corporal Rotation III technique which corrects the most severe degrees of ventral penile curvature without loss in length, though with a certain degree of narrowing. Objective To describe Shaeer’s Corporal Rotation IV, aiming at correction of moderate to severe ventral penile curvature with minimal shortening, minimal narrowing, minimal mobilization of the neurovascular bundle, among other improvements such as using thicker suture material to decease recurrence while inverting the surgical knots. Methods Forty-two patients with congenital ventral penile curvature were selected for the study with the curve ranging from 60 to 90 degrees. Patients were randomized into one of the two groups: Shaeer’s Corporal Rotation III (SCR-III) and Shaeer’s Corporal Rotation IV (SCR-IV). In SCR-IV, rotation is used to correct the main brunt of curvature, up to 70–80% of the curve. Plication is used to correct the residual curvature up to 100% straightness. This keeps the rotation points fewer and closer to the midline, thereby minimizing narrowing and mobilization of the neurovascular bundle. Both groups were compared as regards intra-operative erection angle, length and girth, before and after rotation, as well as subjectively-reported post-operative recurrence, penile sensitivity, satisfaction and IIEF. Results Post-correction angle was zero for all cases in the two groups. Dorsal length decreased by 3% in SCR-IV, compared to 0.5% in SCR-III (2.5% difference). The difference in circumference between narrowest and widest points was 2% in SCR-IV versus 9.3% in SCR-III (7.3% difference). Average operative time was 19.2% shorter with SCR-IV. Girth asymmetry was reported in 1/21 patients in SCR-IV (4.8%), compared to 15/21 in SCR-III (71.4%). Partial hyposensitivity of the penis was reported in 9.5% among SCR-IV compared to 19% in SCR-III. Conclusions Shaeer’s Corporal Rotation IV technique corrects moderate and severe degrees of congenital ventral penile curvature, with little or no compromise in penile length, girth or sensitivity. Disclosure No.

DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases

A total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014. To investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias. In all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year. At the final postoperative follow-up, the patients' satisfaction with the operation was found to be 95.8%. Shortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction. The limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events. According to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures.

Giammusso corporoplasty for the treatment of isolated congenital ventral penile curvature: Results and long-term follow-up.

The aim was to retrospectively evaluate our experience in a large series of patients affected by isolated congenital ventral penile curvature, surgically treated using a previously described modified incisional corporoplasty. Two hundred and six patients with isolated congenital ventral penile curvature underwent a modified incisional corporoplasty. Mean age at surgery was 20.7±5.5years, and degree of ventral curvature was 60±23°. After the point of maximum convexity identification, Buck's fascia was vertically opened along the deep dorsal vein, which was partially ligated, resected and removed. Tunica albuginea was then longitudinally incised and transversally closed. Post-operative follow-up examination was performed at 2weeks, 6, 12 and 24months and then annually. Surgical time was 79±12min. At follow-up, 189 out of 198 patients (95%) were completely satisfied, four patients (2%) complained a recurrence of penile curvature, and 6 (3%) complained about shortening of the penis. None of the patients had any interference with sexual activity. One patient (0.5%) showed erectile dysfunction 5years after surgery, but there was no organic dysfunction during examination. The proposed technique allows correction of ventral congenital penile curvature without dorsal neurovascular bundle manipulation, resulting in minimum trauma of the erectile tissue, without injury to nerve fibres.

A universal mathematical model applied to the congenital ventral penile curvature.

The macroscopic dynamic of fetal penis development presents a pattern resembling the unfolding of a spiral, so congenital ventral penile curvature could indicate that this natural sequence has been interrupted. Our aim in this article is to offer a mathematical model of congenital ventral curvature of the penis. Five individuals who presented with congenital ventral penile curvature and three who presented with acquired penile ventral curvature due to Peyronie's disease were evaluated. The penises were photographed during an induced erection test and the penile curvature patterns were compared with an equiangular spiral. When an association was found, a potential relationship to the golden spiral-a type of equiangular spiral-was also assessed. The mathematical spiral relationships were analyzed using Wolfram CDF Player® (Logarithmic Spiral) and PhiMatrix® software. The Wolfram software generated logarithmic spirals equivalent to the penile curvature with appropriate mathematical values. The PhiMatrix software, which builds any golden spirals from golden rectangles, was used to check whether the spiral was golden as well as equiangular. An equiangular spiral that was also golden was found in all cases of congenital ventral penile curvature. In contrast, none of the acquired penile ventral curvature cases showed a specific pattern. Congenital ventral penile curvature has the mathematical pattern of a golden spiral. Our results offer a mathematical algorithm for potential use in surgical reconstruction procedures, regenerative medicine, tissue engineering, robotics, and body-machine interfaces.

587 Long-term outcome of dorsal approach in the treatment of congenital ventral penile curvature

587 Long-term outcome of dorsal approach in the treatment of congenital ventral penile curvature

Do adult men with untreated ventral penile curvature have adverse outcomes?

Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p < 0.001), more unhealthy mental days (8.6 vs 6.2, p = 0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p < 0.001). Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood.

Shaeer's Corporal Rotation III: Shortening-Free Correction of Congenital Penile Curvature—The Noncorporotomy Technique

BackgroundShortening-free correction of congenital ventral penile curvature by rotation of the corpora cavernosa was first introduced in 2006 (Shaeer's corporal rotation I). The basic principle was shifting the concavity of both corpora cavernosa from the ventral aspect of the penis to the lateral aspects, in opposition. Rotation was achieved by approximating short parallel incisions on the dorsum of both corpora cavernosa. In 2008, we reported modification of the technique (Shaeer's corporal rotation II), in which the incisions spanned the whole length of the corpora cavernosa. ObjectiveThe current modification, Shaeer's corporal rotation III (the noncorporotomy technique) simplifies corporal rotation further and addresses shortcomings. Design, setting, and participantsThis is a retrospective study of 127 cases of congenital ventral penile curvature 25–90° operated at Kamal Shaeer Hospital, Cairo, Egypt, from 2009 to 2015. Surgical procedureThe neurovascular bundle was mobilized, and the corpora were rotated by approximating premarked respective points on either side of the deep dorsal vein using polyester sutures without incising the tunica albuginea. Outcome measurements and statistical analysisIntraoperative postrotation angle and erect length and girth. Results and limitationsOn-table measurements showed a mean prerotation erection angle of 66.5°±17.9° (range: 25–90°; median 65°). Following rotation, the angle was 0.47°±1.8° (p<0.001) and length was 0.06±0.25cm longer (p=0.007), whereas girth was 0.77±0.9cm narrower (p<0.001). Complications included 11 cases (8.7%) of ventral wound gaping and 3 (2.4%) with mild recurrence not requiring correction. The International Index of Erectile Function was 24.99±0.9, with an increase of 13.35±3.4 over the preoperative state (p<0.001). ConclusionsShaeer's corporal rotation III enables correction of any degree of ventral congenital penile curvature, with neither shortening nor erectile dysfunction. Patient summaryShaeer's corporal rotation is a surgical technique for correction of severe degrees of innate downward curvature of the penis, without shortening.

New surgical technique for ventral penile curvature without circumcision.

To describe and report on our variant of penile corporoplasty, the ‘double-breasted’ corporoplasty, with penoscrotal and infrapubic access not requiring circumcision. The medicolegal aspects of treatment are also discussed. Between February 1995 and October 2012, double-breasted corporoplasty was performed in 93 patients with congenital ventral penile curvature. Preoperative assessment comprised RigiScan monitoring, prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of the International Index of Erectile Function-5 (IIEF-5) questionnaire, and biothesiometry up until 5 years ago when it was substituted with the Genito Sensory Analyser for testing sensitivity. Dorsal infrapubic access was used in the patients with ventral curvature. After preparation and incision of Colles' fascia, the penis is degloved and double-breasted corporoplasty is performed at the site established at preoperative assessment. The tunica albuginea is prepared, an incision is made, and the cavernous tissue is isolated from the albuginea to obtain two flaps that are then overlaid and sutured asymmetrically with interrupted 2-0 polyglactin 910 (Vicryl®) sutures. After the free edge of the albuginea is sutured with a running polyglactin 910 suture, a non-absorbable monofilament and uncoated suture made of polypropylene (Premicron®) suture is placed at the point of maximum traction. Complete correction of penile curvature was achieved in 96% of patients; recurrence occurred in 4%. No major complications were reported, nor were there neurovascular lesions or change in erectile function. Palpable subcutaneous irregularities at the site of the corporoplasty, without functional or aesthetic impairment, were reported by 35% of patients. There was no change in the appearance of the penis as circumcision was not performed and the residual scar was barely noticeable as it was hidden in the infrapubic fold. The corporoplasty technique can adequately restore the patient's psychophysical integrity, making it, from a medicolegal perspective, one of the most reliable procedures in the surgical repair of penile curvature. This original technique is associated with low morbidity, a low recurrence rate and excellent aesthetic results. The results show that it is safe and effective. When indicated for the surgical treatment of penile curvature, the choice of the technique satisfies the criteria of diligence and prudence for the surgeon's conduct.

Penile Septoplasty for Congenital Ventral Penile Curvature: Results in 51 Patients

Penile Septoplasty for Congenital Ventral Penile Curvature: Results in 51 Patients

Penile Septoplasty for Congenital Ventral Penile Curvature: Results in 51 Patients

The technique most widely used to correct congenital ventral penile curvature is still corporoplasty as originally described by Nesbit. We present results in patients treated with a variation of Nesbit corporoplasty used specifically for congenital ventral penile curvature. From June 2000 to June 2007 we treated 51 patients with congenital ventral penile curvature using modified corporoplasty (septoplasty), consisting of accessing the bed of the penile dorsal vein and excising 1 or more diamonds of tunica albuginea from it, extending in wedge-like formation 4 to 5 mm deep into the septum, until the penis is completely straightened. Patient history, clinical findings, self-photography results and the International Index of Erectile Function score were assessed. Curvature grade is expressed using the equation, 180 degrees - X, where X represents the deviation in degrees from the penis axis. Mean preoperative ventral curvature was 131.4 degrees (median 135, range 145 to 110). Of the patients 13 also had erectile dysfunction. At followup postoperative mean ventral curvature was 178.3 degrees (median 179.1, range 180 to 175). A total of 49 stated that they were completely satisfied. Penile shortening was 5 to 15 mm. Compared to preoperative values there were marked improvements in the International Index of Erectile Function score in the various groups. No major postoperative complications developed. In 4 patients wound healing occurred by secondary intent. This technique provides excellent straightening of the curved penis. By avoiding isolation of the whole dorsal neurovascular bundle there is no risk of neurovascular lesions. Suture perception is minimized.

Simple dorsal plication near the 12 o'clock position for the correction of congenital ventral penile curvature.

Fourteen patients with congenital penile curvature without hypospadias were treated with a modified Essed dorsal plication method between 1998 and 2002 in our clinic. Patient age ranged between 20 and 25 years (mean 22.2). Eight cases (57.1%) had ventral curvature only and six had an additional lateral curvature. There were no significant postoperative complications. One (7.1%) patient had early suture breakage on the 21st postoperative day during erection and underwent re-operation after 9 months. After a mean follow-up period of 23.2 months (range 3-46) all patients were satisfied with the procedure except for one patient (7.1%) who had a residual curvature of 20 degrees. Four cases (28.6%) had minimal shortening of the penis. The overall satisfaction rate with the procedure was 93%. Simple dorsal plication near the 12 o'clock position is a minimally invasive and effective method for the treatment of congenital ventral penile curvature.

Long-term results of Essed-Schroeder plication by the use of non-absorbable Goretex sutures for correcting congenital penile curvature.

This study evaluated the long-term outcome of the Essed-Schroeder procedure for correcting congenital penile curvature using non-absorbable Goretex sutures. The Essed-Schroeder procedure was performed in 35 patients with congenital ventral penile curvature (minimum 30 degrees ). Follow-up included a standardized interview with measurement of angulation. Twenty-three of 35 patients were available for complete long-term follow-up (average 34.3 months). The mean preoperative ventral curvature was 54 degrees. In 17/23 patients, the penis remained straightened. Recurrent curvature (average 23 degrees ) was observed in six of 23 patients. Fifteen of 23 patients complained of penile shortening (average 1.8 cm). Two of 23 patients reported disturbing side effects that were caused by plication nodes. In most cases, the results of penile straightening by the Essed-Schroeder procedure are excellent with a high grade of subjective satisfaction. Regarding the main problem, that is recurrent curvature, there is no decisive advantage of applying Goretex sutures. Discomfort caused by plication nodes can be reduced to a minimum by using a combination of soft Goretex sutures with the 'inverting stitch-technique'.