Dorsal Penile Curvature Research Articles

(136) A NONINTERVENTIONAL, RETROSPECTIVE MULTICENTER STUDY TO EVALUATE CCH TREATMENT IN ADULT MALE PARTICIPANTS WITH VENTRAL CURVATURE OF THE PENIS DUE TO PEYRONIE’S DISEASE

Abstract Introduction Peyronie’s disease (PD) is a connective tissue disorder characterized by the replacement of normal elastic fibers of the tunica albuginea with collagen-containing plaques. This alteration may result in penile deformities that are most evident during erection, which can lead to significant emotional distress, sexual dysfunction, and penile pain. Collagenase clostridium histolyticum (CCH) is indicated for the treatment of adult men with PD with a palpable plaque and curvature deformity of at least 30 degrees at therapy onset. Notably, men with ventral curvature (VC) were not included in the CCH clinical trial program due to potential concerns over the proximity of the urethra to the site of injection. Currently, CCH is contraindicated in Peyronie’s plaques that involve the penile urethra. Urethral involvement of a PD plaque is rare due to the anatomy of those structures. PD plaques form in the tunica albuginea as opposed to the corpus spongiosum which directly surrounds the urethra. Also, multiple prospective and retrospective studies have documented favorable outcomes using CCH for PD with VC. Thus, CCH may be a reasonable treatment option for patients suffering with ventral and ventrolateral penile curvatures in the absence of direct urethral involvement. Objective We are conducting a multicenter real-world retrospective collaborative research study of the safety and effectiveness of CCH in the treatment of men who had PD with VC. Methods A Phase 4, multicenter, noninterventional, retrospective review of medical records from approximately 10-15 US physician sites is being conducted. Eligible patients include those ≥18 years old with a PD diagnosis with VC and a palpable plaque that had been treated with CCH from 2014 to the study start date at the site. The primary effectiveness endpoint is percent change from (pretreatment) baseline in degree of VC at the last visit as measured at follow-up within 6 months post-treatment. Secondary endpoints include mean change from Baseline in VC and the proportion of patients with ≥30% improvement from baseline in VC at the last visit during which a measurement was collected within 6 months of final CCH treatment. Adverse events are collected throughout the study period to assess safety. Results In this first look at early data, 32 eligible patients with a median age (range) of 58.0 years (25-75 years) were included in the analysis. The percent change in penile curvature from baseline decreased, representing an improvement of 45.4% (SD: 28.62 [0-100]) (Figure), with 68.8% (22/32) of patients experiencing ≥30% improvement from baseline in VC. There were no serious adverse events. Five patients had at least one treatment-related adverse event (TRAE); 4 TRAEs were mild-to-moderate in severity and 2 were unknown. There were no reports of urethral involvement or injury. TRAEs were related to injection site bruising (n = 3), hemorrhage (n = 1), swelling (n = 1), and muscle spasm (n = 1). Conclusions This first look at early data reflecting improvements in men with PD and VC (data cutoff: 06/14/2024) is consistent with findings of effectiveness and tolerability of CCH in the treatment of men with dorsal and dorsolateral penile curvature. Disclosure Yes, this is sponsored by industry/sponsor: Endo USA Inc. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: MZ is an investigator and consultant for Endo USA Inc. MI is an investigator for Endo USA Inc. AT is an investigator and consultant for Endo USA Inc. RB is an investigator for Endo USA Inc. JM is an investigator and consultant for Endo USA Inc. JT is an employee of Endo USA Inc. DH is an employee of Endo USA Inc. GK is an employee of Endo USA Inc. KG is an investigator and consultant for Endo USA Inc. JA is an employee of Endo USA Inc. TR is an employee of Endo USA Inc. MA is an employee of Endo USA Inc. JM is an investigator for Endo USA Inc.

Corporeal derotation for the management of dorsal penile curvature associated with epispadias or bladder exstrophy

Corporeal derotation for the management of dorsal penile curvature associated with epispadias or bladder exstrophy

(164) Technique of Plaque Excision and Coroporoplasty Using Free Tunica Vaginalis Graft

Abstract Introduction Severe penile curvature causing inability to perform pleasurable sexual activity is the most dreadful sequel of Peyronie disease. Surgical plication methods have their limitations of recurrence of curvature or penile shortening which is not acceptable to patients. In cases of severely calcified plaques, excision of the plaque with grafting of the defect remains the only viable option. Several graft materials have been used for repairing the defect. We present our experience of Plaque excision and coroporoplasty using local tunica vaginalis free graft. Objective To demonstrate the technique of free tunica vaginalis free graft corporoplasty for severe curvature due to Peyronie plaque. Following steps of corporoplasty are demonstrated. Penile degloving, artificial erection and plaque demarcation, dissection of the neuro-vascular bundle, plaque excision, harvesting the tunica vaginalis graft, corporoplasty using tunica vaginalis, restoration of neuro-vascular bundle, closure of scrotal wound and completion of circumcision. Methods 7 patients between the age group of 47 to 68 years (mean age 54.6 years) were operated using this technique between 2018 to 2022. All patients had dorsal penile curvature with hard palpable plaque ranging from 2.5 cm to 5.2 cm. All patients were evaluated objectively using auto-photography. Penile doppler was done in all patients to confirm pre-operative arterial flow. Plaque exposure was done by penile degloving. Tunical graft was harvested by midline scrotal incision. Complete plaque excision was done and graft was sutured with 3–0 Prolene sutures. Results All patients had normal erectile function after the surgery. The maximum follow-up period was 42 months. All patients reported normal sexual function after a month of surgery. 2 patients complained of persistent induration and hardness at the site of graft, however the function being normal. Penile length shortening was noted in 4 patients which ranged between 4–6% of previous length, however it did not alter the sexual function. Conclusions Complete excision of the Peyronie plaque with corporoplasty using free tunica-vaginals graft is an effective, cost-effective and functionally acceptable technique for patients with hard and calcified plaque offering excellent functional outcomes. Disclosure No.

(036) The Comparison of an Efficacy and Safety of Geometrical Principles Based Corporoplasty Combined with Intraoperative Intracavernosal Prostaglandin E1 Injections and the Non-Geometrical Surgical Techniques for Peyronie's Curvature Correction

Abstract Introduction There is a lack of research evidence and properly conducted comparative long-term studies in regards to whether the intra and post-operative safety and efficacy of geometrical principle of plaque incision and grafting technique, especially if combined with an intraoperative intracavernosal prostaglandin E1 (PGE1) injection instead of saline, is better than the non-geometrical techniques. Objective The aim of this retrospective study was to present our 8-year single-center experience of surgical management of Peyronie's disease in the means of efficacy and safety by comparing geometrical principle of plaque incision and grafting technique combined with the intraoperative intracavernosal PGE1 injection with the other non-geometrical surgical techniques used at our centre for the treatment of penile curvature. Methods Our andrology centre approved this retrospective study and commenced an audit in order to obtain anonymised data. In total 70 patients underwent non-geometrical surgical techniques based penile curvature correction between 2014 and 2017. All the surgeries were carried out performing the intraoperative intracavernosal PGE1 injection instead of obtaining saline-induced erection. The demographic data was retrieved and a comparative analysis was performed. Results In total 216 (N=216) patients, aged 42–73 years old (average age 59 years) suffering from Peyronie's disease had surgical treatment of the curvature at our centre from 2014 to 2023. Group 1 (G1) patients accounted for 32.41% (N=70) of total patients - they were 46–78 years old (average age 64 years) and underwent non-geometrical principals based surgery for Peyronie's disease in between 2014 and 2017. Group 2 (G2) patients accounted for 68.52% (N=148) of total patients - they underwent the surgery using plaque's incision and grafting technique based on geometrical principles in between 2018 and 2023. 31 patients (44.3%) out of G1 required additional curvature corrections after an initial surgery, but only 3 patients (2.0%) out of G2 required that. Preoperative dorsal penile curvature degree among G1 was 50° - 100° (the mean degree 70°) and 60° - 110° (the mean degree 78°) among G2. 11 patients (15.7%) out of G1 and 15 patients (10.1%) out of G2 had the combined dorsolateral curvature. 3 patients (4.3%) out of G1 and 6 patients (4.1%) out of G2 had ventral curvature. 9 patients (12.9%) out G1 and 2 patients (1.4%) out of G2 have reported a subjective statement of their penile shaft appearing shorter after the curvature correcting surgery. 2 patients (2.9%) out G1 and 1 patient (0.7%) out of G2 have reported a subjective statement of erectile dysfunction post the surgery. There were no intraoperative or postoperative complications associated with the intracavernosal PGE1 injection. Conclusions In summary, we found that plaque's incision and grafting technique based on geometrical principles was advantageous against the other non-geometrical penile curvature surgical techniques due to better efficiency achieved by the higher initial success rates that require an additional correction almost twice less often. We also revealed that the intracavernosal PGE1 injection was a safe and sufficient method for inducing erection intraoperatively, that had not been associated with any complications and maintained the good outcomes of the surgical Peyornie's disease treatment. Disclosure No.

Penile reconstruction after complete bladder exstrophy repair

The decreased penile length in patients born with bladder exstrophy (BE) results partly from pubic symphysis diastasis and the separation of the corporal bodies. Also, intrinsic shortening of anterior corporal compartment, residual penile dorsal curvature, and postsurgical scarred skin share in creation of short penile length. The goal of this study was to look at whether adult men who had bladder exstrophy (BE) surgery as babies needed and benefited from penile reconstruction, which included penile lengthening and repair of any redo penile pathology that was present at the same time. We reviewed the records of 31 repaired BE patients with mean age of 21.4±3.7 years. The patients complained of their dissatisfaction with short penile length, residual dorsal penile curvature, distal dorsal or hypospadiac urethral opening and scared penopubic skin. The penile lengthening was performed by sub-periosteal detachment of the corporal bodies from the pubic rami in all cases. In 8 patients full thickness dermal grafts were used to penile resurfacing after its lengthening. Twelve patients underwent coronal or glanular urethroplasty. Phalloplasty was performed in one patient using forearm free graft. Subjective evaluation by the patient reported satisfactory results in 25/31 (80.6%). The degree of penile lengthening measured at 6 months and one year postoperatively showed increased length which varied between 50% and 150% of the preoperative penile length. We hypothesize that congenital causes, such as short anterior corporeal compartment, wide pubic rami diastasis, and short penile urethra, as well as iatrogenic causes, such as post-surgical peno-pubic scars, could account for the coexisting multifactorial causes of penile shortening in male adults with BE. Penile lengthening is permitted, in our opinion, provided that the crura from the pubic rami is carefully and partially mobilized. The short phallus, residual dorsal chordee and distal urethroplasty can be corrected successfully in the majority of patients. Adult males with BE may have short penis that requires another reconstructive stage. The short phallus, residual chordee and distal urethroplasty can be corrected` successfully in the majority of patients.

An original mininvasive corporoplasty technique for penile curvature without circumcision

We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient's erectile function. Scrotal access was performed in patients with dorsal and/or lateral penile curvature; the infrapubic access was performed in patients with ventral curvature. After preparation and incision of Colles' fascia, penis was partially degloved and an original plication technique called "binary corporoplasty" was performed at the site or sites established at preoperative assessment, with non-resorbable synthetic multifilament (Premicron®) suture. Complete correction of penile curvature was achieved in 96.8 % of patients. No major complications were reported, and no patients suffered worsening in erectile function or in penile sensitivity. The average shortening of convex side was 1.65 cm (± 0.7 cm) and all patients report easy intercourse after correction. The average time of surgery was 46 minutes (± 11 min) and all procedures were performed as a day-hospital or ambulatory settings, with local anesthesia and light sedation. Overall satisfaction rate is 96%. This is a simple and rapid technique that perfectly corrects even the most severe and complex penile curvatures. In comparison to traditional techniques, such as Nesbit procedure, this technique is associated with low morbidity, a very low recurrence rate and a great aesthetic results. Aesthetic and functional patients' satisfaction was excellent.

Xiaflex® Treatment for Peyronie's Disease May Improve Penile Curvature Degree With No Effect on the Loss on Penile Length in Post-marketing Analysis

ABSTRACT Introduction One of the main complaints of patients with Peyronie's Disease (PD), besides the curvature, is penile shrinkage. Both deformities result in significant distress to the patient and his partner. XIAFLEX has been developed to treat Peyronie's plaques with substantial improvement of the curvature in the IMPRESS TRIAL. Objective In this study, we perform a post-marketing analysis to see if there is any significant improvement of stretched penile length, erect penile length and erect circumference in patients who respond to XIAFLEX compared to patients who do not. Methods Consecutive patients treated with XIAFLEX for dorsal plaque and penile curvature above 30 degrees in the absence of hourglass deformity were included in this study. Penile curvature was assessed using a goniometer after induction of artificial erection using alprostadil, before treatment, and eight weeks after the end of the 4th cycle. Stretched and erectile length, as well as erectile circumference, were measured at the same setting. Based on the results of the IMPRESS trial, we decided that any improvement over 15 degrees was deemed a positive response (given our initial measurements were in increments of 5 degrees). Results 148 patients with PD and penile curvature above 30 degrees elected and completed 4 cycles of non-surgical intervention were included in this study. In this cohort, 129 (87%) of patients had improvement over 15 degrees after completing eight total injections of Xiaflex. The average penile curvature at the beginning of the study was 61.4 degrees, while stretched penile, erected penile length, and erected circumference were 13.9 cm, 13.3 cm, and 11.8 cm respectively. The figure shows no significant change in neither the erect nor the stretched penile length in patients who responded to the injections. However, there was a significant decrease in the erect circumference in the majority of patients from an average of 11.8cm to 9.3cm. Conclusions There appears to be no significant regain of the penile length in which patients often complain about losing due to Peyronie's disease in those who respond to Xiaflex injections. The study finding suggests that the erect circumference might decrease, not necessarily due to the injection itself but due to the disease or recovery process. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals

Dorsal penile curvature and megameatus intact prepuce hypospadias: A common association in a rare variant of hypospadias

Megameatus intact prepuce (MIP) is a rare variant of hypospadias. Unlike the hooded ventrally absent prepuce in non-MIP hypospadias, the prepuce in MIP hypospadias is fully circumferential and intact. The distal urethra remains wide with a deep glanular groove. While ventral curvature is a common finding in non-MIP hypospadias, neither ventral nor dorsal penile curvature has been reported in MIP hypospadias. To assess the association of the MIP hypospadias variant with penile curvature. We retrospectively reviewed the medical records of all children who underwent hypospadias repair and identified those who were documented as having the MIP variant of hypospadias and operated in our center from January 1998 to June 2020. The patients were considered as having MIP hypospadias if no hypospadias had been evident before circumcision, if a circumferential circumcision scar was present (instead of the inverted V-shaped scar in the ventral aspect of the penis following circumcision of the hooded prepuce associated with non-MIP hypospadias), and if there was a wide meatus. Penile curvature was diagnosed intraoperatively by an artificial erection test that uses saline solution for injection. Patients were considered surgical candidates if the degree of curvature was equal to or greater than 30°. The study cohort consisted of 118 male children who were identified as having the MIP hypospadias variant according to the inclusion criteria. The median age at repair was 1.1 years (interquartile range 8 months to 1.6 years). Penile curvature was found in 29 children (24%), of whom 23 had dorsal curvatures (19%) and 6 had ventral curvatures (5%). MIP hypospadias is associated with penile curvature, and more frequently with dorsal than ventral curvature. This study is retrospective and does now identify specific features of MIP associated with penile curvature. We encourage pediatric urologists to perform an artificial erection test intraoperatively in children with the MIP variant and repair associated curvatures. A dorsal curvature was found in 19% of patients with a MIP variant of hypospadias, and most of them (86%) required ventral plication due to the severity of the curvature.

Устранение дорзального и латерального искривления полового члена у детей с гипоспадией

Lateral and dorsal curvature of the penis in hypospadias in children are very rare conditions. Articles dealing with correction of these rare forms of curvature in children are not easy to find. The objective of this work was to improve the outcomes of treating children with hypospadias and rare (dorsal/lateral) forms of penile curvature. Patients and methods. The study included 49 patients with coronary and penile hypospadias, chordee with hypospadias, and also with rare forms of curvature – dorsal and lateral at 30-45 degrees. Depending on the form of penile curvature the patients were divided into 2 groups. Group 1 – 36 patients with dorsal curvature, who underwent ventral plication of the corpora cavernosa; group 2 – 13 patients with lateral curvature and lateral plication of the contralateral corpus cavernosum (9 patients had a curve to the left and 4 – to the right). Results. No penile curvature in the early post-operative period and a year afterwards was not noted in patients of both groups. Dorsal penile curvature occurs in 5% of cases, and lateral in 1.7% of cases. Conclusion. The use of the method of plication of the corpora cavernosa opposite the curvature makes it possible to obtain good functional and cosmetic outcomes of management of hypospadias. Key words: lateral curvature, dorsal curvature, hypospadias, curvature correction

Congenital prepubic sinus with dorsal penile curvature: a case report and literature review

BackgroundCongenital prepubic sinus (CPS) is a rare congenital anomaly and widely thought to be a variant of urethral duplication. Histological examination of this case gives a clue to this theory. CPS with dorsal penile curvature has been reported in previous publications, but their procedures to correct the curvature are different from this case.Case presentationA 10-year-old boy complained of the pain in the dorsal base of the penis. Physical examination revealed an accessory meatus located in the midline of the dorsal proximal penis and moderate dorsal penile curvature with deficient dorsal foreskin. Imaging examination showed that the meatus did not communicate with either normal urethra or urinary bladder, and ended blindly at the level of the symphysis pubis. The intact 4-cm-long sinus was completely separated and excised. Penile curvature was corrected after the dorsal proximal fibrous cord was detached. Histological examination confirmed the diagnosis of urethral duplication.ConclusionsThe histological result of this case supports the theory that CPS is a variant of the dorsal urethra. Moreover, this case indicates that the curvature in patients with CPS may be caused by the dorsal fibrous cord at the beginning and the operation should be conducted at an early age to avoid further development of the curvature during puberty.

Primary Treatment of Peyronie’s Disease: A 55-yr-old Male with 45° Dorsal Penile Curvature and Good Erectile Function

Peyronie's disease is an abnormal curvature of the penis that affects sexual intercourse. The treatment options include injection therapy into the scar or surgical correction of the curvature using plication or grafting.

Congenital prepubic sinus (an epispadiac variant of dorsal urethral duplication) with dorsal penile curvature in an adult man: a rare association

Urethral duplication is among a very rare congenital disorder with multiple anatomical variants reported. Urethral duplication of complete type is usually diagnosed during childhood with urinary incontinence or double urinary...

HP-09-004 TachoSil® and the geometric principles of the Egydio technique-a valid and safe combination

To explain and demonstrate the use of a collagen fleece (TachoSil®) as a graft material for severe penile curvatures, which demand an incision and grafting procedure based on the geometric principles of the Egydio technique. To highlight tips and tricks for a correct application of TachoSil® and the geometric principles of the Egydio technique. From March 2016-August 2016 a total of 18 patients underwent an incision and grafting procedure based on the geometric principles of the Egydio technique due to a severe penile curvature caused by Peyronie's disease. Inclusion criteria were: patients with severe Peyronie's disease - patients with good quality erections - patients who were concerned about further penile length loss. 16 patients had a dorsal penile curvature, and 2 patients had a lateral penile curvature. The mean penile curvature was 70 degrees (range, 50-100 degrees). All dorsal penile curvatures were straightened. One of the lateral curvatures had to be revised due to a residual curvature of > 20°. A residual curvature of less than 10 degrees was present in 2 patients. Permanent glans numbness was not present. The intraoperative measured stretched penile length increased by 2.0 cm (range, 1.5-3.0 cm). In foreskin sparing approaches (12 cases) a postoperative lymph edema of the foreskin was present in 50% of cases. All lymph edemas dissolved over the first 6 weeks. All patients resumed sexual intercourse postoperatively. No postoperative erectile dysfunction was recorded.

PS-07-004 Ventral median yachia under spongiosum body: a novel approach for correction of dorsal penile curvature

PS-07-004 Ventral median yachia under spongiosum body: a novel approach for correction of dorsal penile curvature

Tunica‐sparing ossified Peyronie’s plaque excision

Ossified Peyronie's plaques may require surgical excision because of the palpable problems and penile curvature that result. As tunical excision can result in impotence and decrease penile sensation, we describe a novel method of tunical preserving excision of such lesions. We evaluated 12 men with dorsal penile curvature between 10° and 90°. Penile plaque size ranged from 1 to 5 cm. 80% had painful erections. An artificial erection was induced with intracavernous injection of papaverine to assess penile deformity. Via a circumcising or ventral incision, plication sutures were placed to correct penile curvature. A lateral longitudinal corporotomy was made and the calcified/ossified portion was dissected free from the tunica albuginea/plaque of the corpora cavernosa. Watertight tunical closure was then performed. Postoperatively, 80% of men reported erections always adequate for intercourse and normal sensation with a mean follow-up of 7 months (range 2.1-14.5 months). All patients required simultaneous penile plication to ensure a straight phallus. Pathologic evaluation of plaque specimens all showed bone fragments. Tunica-sparing excision of the ossified/calcified portion of Peyronie's plaques shows a durable benefit for large, ossified lesions and maintains potency and penile sensation.

Ventral Plication for Repair of Pediatric Dorsal Penile Curvature

To present the results of ventral plication for the repair of dorsal curvature. A total of 33 patients (mean age 38 months, range 7 months to 15 years) with a dorsal curvature of >30 degrees degrees underwent ventral plication. A subcoronal incision was performed, followed by degloving of the skin to the penile base. The point of maximal curvature was noted and marked during an erection test. Two polypropylene 5-0 plication sutures were placed in the tunica albuginea of both corporeal bodies, just lateral and adjacent to the corpus spongiosum. Proper alignment and a straight penis were confirmed with a repeat erection test. The skin incision was closed with absorbable sutures. Surgical success was determined by parental and physician satisfaction with the final outcome during follow-up. No immediate or late complications (mean follow-up 25 months, range 3-65) developed. A straight penis was achieved in 28 of 33 patients (85%). Four patients with residual curvature did not require a second procedure, and the fifth patient successfully underwent reoperation using the same technique. The results of our study have shown that ventral plication is a simple and efficient technique for the repair of dorsal penile curvature.

Epispadiac Urethral Duplication in an Adult Dorsal Deviated Penis

Urethral duplication is a rare congenital anomaly. Most male patients with complete urethral duplication are diagnosed at childhood with presentation of double urinary streams or urinary dribbling. Incomplete urethral duplication does not result in obvious symptoms except intermittent discharge from the epispadiac urethral opening. Here we report a case of incomplete urethral duplication presenting with severe dorsal penile curvature since adolescence and consequent difficulty with sexual intercourse. We not only corrected the penile curvature but also removed the epispadiac tract followed by a tenuous cord, which suggest that this cord may limit the development of the corpus carvernosum asymmetrically.

Plaque incision and venous patch grafting for Peyronie's disease.

To evaluate the results of plaque incision and venous patch grafting to correct the dorsal curvature associated with Peyronie's disease. 18 patients with Peyronie's disease were treated surgically. All of the patients have dorsal penile curvature for more than one year causing intromission impossible or with some difficulty because of curvature. Median penile angulatio was 60 degrees (range 45 degrees-75 degrees). A transverse incision about 2 cm long was made on the plaque where maximal site of curvature was identified. The saphenous vein harvested from the ankle region is opened longitudinally and its endothelial surface is placed and sutured in contact with the tunical defect. Complete penile straightening was achieved in 16 (88.8%) cases and only two patients have residual curvature less than 30 degrees permitting sexual intercourse. None of the patients returned to baseline preoperative angulation state in the follow up period. 3 patients (16.6%) reported penile shortening, but only one was concerned and showed dissatisfaction about it. 6 patients (33.3%) have transient changes in penile sensation that resolved within 4 months. Plaque incision and placement of saphenous vein patch graft offers a 94.4% satisfactory result in Peyronie's disease causing penile dorsal curvature.

CONGENITAL DORSAL PENILE CURVATURE: A POTENTIAL PROBLEM OF THE LONG PHALLUS

Purpose We report the results of surgical correction of severe congenital dorsal penile curvature associated with a long slender phallus. Materials and Methods In the last 7 years we treated 16 boys with a mean age of 2 years 10 months who had severe dorsal penile curvature. The series included 5 patients with megameatus variant hypospadias and a full foreskin, 3 who presented with hypospadias and 8 who were referred when dorsal penile curvature was noticed by the family or primary physician. Mean penile length was 6.5 cm. without stretching. In each case length was greater than 2 standard deviations above the mean for patient age. Penile circumference decreased from a mean of 4.2 cm. at the base of the shaft to 4.1 cm. at the mid shaft and 3.7 cm. at the corona. Penile circumference was generally normal for patient age until corrected for length, when it was revealed to be small. Surgical correction of severe curvature was performed in 14 patients, while 2 who presented as newborns had remarkable spontaneous improvement in the first year of life. In each case curvature was due to corporeal disproportion. Results All patients have erections postoperatively. There has been no residual or recurrent curvature and cosmetic results are good. Conclusions Congenital dorsal penile curvature is a potential problem of the long phallus. In severe cases surgical repair improves the appearance of the penis but it must also address the problem of corporeal disproportion.

Unusual Complications of the Vacuum Erection Device

Objectives. The vacuum erection device (VED) is usually well tolerated and very effective for patients with erectile dysfunction. When used correctly, VEDs carry low morbidity and few recognized complications. We report on 5 patients who developed unusual complications associated with VED use, including two previously unreported complications of urethral bleeding and capture of scrotal tunica within the penile shaft. Methods. Patient 1: a 38-year-old diabetic man with significant peripheral neuropathy and an 8-year history of erectile dysfunction developed penile skin necrosis at the ring site after leaving the penile ring on for an excessive length of time (6 hours). Patient 2: a 76-year-old diabetic man who used a VED correctly for 3 months developed severe urethral bleeding. Patient 3: a 75-year-old diabetic man who enjoyed satisfactory erections with a VED for 14 months developed a 3 × 3-cm penile cystic mass located on the proximal right side of the penile shaft. This mass was not present in the flaccid state and was seen only with VED use. Patient 4: a 65-year-old man developed Peyronie’s disease after 4 years of correct VED use. Patient 5: a 62-year-old man with neurogenic impotence following a radical prostatectomy developed penile ecchymoses acutely following placement of a smaller constriction ring. He subsequently developed a dorsal penile plaque with mild dorsal curvature. Results. Patient 1 did well with local skin care and no longer uses a VED. Patient 2 underwent cystoscopy and was found to have prominent urethral vessels (varicosities) in the midurethra, compared with a normal cystoscopy 9 months previously. This patient no longer uses a VED and now denies any urethral bleeding at 15-month follow-up. Patient 3 underwent corpora cavernosography and contrast injection of the cystic mass. These radiographic studies showed that the mass did not communicate with either corpora cavernosa or the corpus spongiosum. A retrograde urethrogram failed to show a urethral diverticulum. The patient was surgically explored, and the penile cystic mass was found to be scrotal tunica vaginalis. Subsequently, a hydrocele repair was performed, yet postoperatively the patient developed testicular migration into the ipsilateral penile shaft. Testicular fixation was not feasible secondary to a childhood herniorrhaphy, and an orchiectomy was performed. Patient 4 underwent implantation of a penile prosthesis and is doing well at 3-year follow-up. Patient 5 experiences mild dorsal penile curvature with erections induced by transurethral prostaglandin E1. The penile curvature does not interfere with intercourse and will be managed conservatively. Conclusions. We describe unusual side effects associated with VEDs. Although thousands of men use VEDs successfully and without morbidity, the urologist must be aware of unusual complications associated with VED use.