Correction Of Penile Curvature Research Articles

(171) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique

Abstract Introduction Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. Objective We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. Methods A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4–0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3–0 Vycril suture. Results This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Conclusions Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. Disclosure No.

(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.

(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.

(192) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique

Abstract Introduction Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. Objective We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. Methods A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4-0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3-0 Vycril suture. Results This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Conclusions Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. Disclosure No.

(173) Initial Experience with ReSheyP Device for Intraoperative Modeling of Peyronie’s Disease After Placement of a Penile Prosthesis

Abstract Introduction Manual modeling to correct penile curvature associated with Peyronie's disease (PD) during penile prosthesis has been a recognized procedure since the 1st publication by Wilson et al in 1992. A key component to optimizing results and minimizing complications (i.e. distal urethral laceration) with manual modeling is proper technique. Manual modeling can be technically challenging as the inflated prosthesis must be maintained bent in the direction opposite to the curvature for up to 60-90 seconds and repeated several times. This can be challenging for the operating surgeon with respect to hand fatigue or even accomplishing the adequate modeling pressure. The purpose of this report is to present initial results with ReSheyP, a device designed to facilitate manual modeling in a more controlled fashion to make it easier to perform and potentially less risky than when done simply by hand. In addition, the device can be used in the postoperative setting to resolve residual curvature. Objective We present on 5 men who underwent placement of an inflatable penile prosthesis with manual modeling using the ReSheyP device. Pre- and post-modeling curvature measurement was performed with a goniometer. Men who had severe indentation deformity were excluded from the study. Methods A retrospective review was performed on patients who underwent penile prosthesis placement followed by ReSheyP modeling in 2023. During the procedure, the ReSheyP was deployed at least 2-3 times for 60-90 seconds per modeling. Data collection included demographics, pre- and post-operative assessment of penile curvature, adverse events and patient satisfaction with postoperative straightening. Results Mean pre-modeling curvature was 62 degrees (range 50-70 degrees) (Table 1). Direction of curvature was dorsal in 3 patients and lateral in 2 patient. The average intraoperative post ReSheyP modeling curvature was 11 degrees and the average change in curvature was 45 degrees. All men reported satisfaction with post-op curve correction. There were no intraoperative or postoperative complications. No patient has felt that further at home modeling was needed. Penile sensation and prosthesis function was uncompromised. Conclusions This pilot study using the ReSheyP device for intraoperative modeling to correct penile curvature after penile prosthesis placement suggests that this tool may be an effective procedure for correcting penile curvature in men with PD. Further experience is necessary and longer follow-up will be reported. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

(171) The Effects of Pretreatment with Xiaflex on Penile Curvature Correction with Manual Modeling During and After IPP placement

Abstract Introduction There are a variety of treatment modalities available to treat Peyronie’s disease (PD), including collagenase clostridium histolyticum (Xiaflex) injections. Patients with concomitant erectile dysfunction (ED) and PD are best served by insertion of an inflatable penile prosthesis (IPP) in order to adequately treat both conditions. Many PD patients may undergo other PD treatments, including Xiaflex, prior to IPP implantation. There are multiple methods of curvature treatment during IPP surgery, and manual modeling is the predominant method in our practice. Little data exists regarding whether Xiaflex treatments prior to IPP placement influence changes in penile curvature during and after IPP surgery with manual modeling. Objective The primary objectives were assessing the impact of pre-treatment with Xiaflex on penile curvature immediately after IPP implantation and after manual modeling. The secondary objective was change in penile curvature post-operatively. Methods All IPP patients with known preoperative penile curvature with and without a history of Xiaflex injections undergoing IPP placement by a single surgeon from January 2017 to June 2023 were included in this IRB-approved (IRB 00031589) retrospective series. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) ranging 16-24cm in length (mean 19.8 ± 1.9cm) with 0-3cm rear tips (mean 1.4 ± 0.9cm). Goniometer was used to assess curvature during preoperative intracavernosal injection and duplex Doppler ultrasound, at multiple points intraoperatively, and postoperatively at 2 weeks, 6 weeks, and 6 months. Biplanar curvatures were recorded as primary and secondary values. SPSS (IBM, Armonk, NY, UA) was used for statistical analyses, which included t-tests, chi-squared tests, and ANOVA. Results Sixty-one patients were included. Preoperative curvature was 35° ± 17° (10° to 70°) for the Xiaflex cohort (n=11) and 41° ± 15° (20° to 80°) for the Xiaflex naïve cohort (n=50). At the time of IPP placement, patients previously treated with Xiaflex had a 19° ± 12° absolute reduction in primary penile curvatures, corresponding to a 45% ± 36% improvement (25° reduction to 5° worsening), while Xiaflex naïve patients had a 20° ± 13° absolute reduction and 54% ± 23% improvement (50° reduction to no change). Similar mean curvature reductions were seen with IPP placement in primary dorsal curves in the Xiaflex cohort (n=7, 21° ± 4°, 51% ± 12%, 25° to 15° reduction) and Xiaflex naïve cohort (n=24, 21° ± 9°, 51% ± 22%, 40° to 5° reduction). There was little difference in change in curvature after modeling between the Xiaflex (11° ± 3°, 63% ± 23%, 15° to 5° reduction) and Xiaflex naïve patients (14° ± 9°, 70% ± 20%, 40° reduction to 5° worsening). Interval assessments postoperatively were also comparable. Sample size precluded assessment of statistical significance among groups. Conclusions Preoperative treatment of PD with Xiaflex does not impede nor significantly improve curvature correction with IPP implantation and manual modeling. Similar changes in penile curvatures were seen in both groups regardless of curvature direction, modeling, or postoperative interval. In patients with severe PD, Xiaflex may be a useful tool to improve preoperative penile curvatures such that they may be more easily correctable with an IPP. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.

(399) Reducing Out-of-Pocket Expenses for Peyronie’s Disease Therapy with a Novel Penile Traction Device

Abstract Introduction Penile traction therapy (PTT) has gained popularity as a nonsurgical approach to penile lengthening and curvature correction in those with Peyronie's disease (PD). PD is an acquired fibrotic plaque that develops within the tunica albuginea and causes penile curvature, which can have significant physical and mental health consequences. Due to the sensitive nature of this disease presentation and the large number of unidentified or misdiagnosed people, current prevalence estimations in the US are around 11%. PD therapies aim to correct penile curvature while also addressing erectile dysfunction and pain. Common PD therapies include oral medications, intralesional penile injections, surgery, and stretching techniques. When deciding which therapies to pursue, disease severity, costs, compliance, and patient access to facilities and trained providers must be considered. Of these therapies, PTT with a penile traction device (PTD), although uncovered by insurance, has proven to be one of the most cost-effective PD treatments. While an effective treatment in some men, PTDs cost hundreds of dollars out-of-pocket. Objective Our project aims to address the financial and practicality concerns of penile traction therapy by creating an affordable and comfortable PTD. Methods Our PTD offers precise, dial-adjustable tensioning and penile holding systems with contoured penile holding plates lined with silicone cushions for improved grip and comfort. Our PTD is 3D-printed using polylactic acid (PLA) and medical-grade silicone. To assess our efforts in improving comfort, we measured holding capacity under tension at increasing amounts of penile clamping. We compared our silicone-lined clamp to an all-plastic clamp: this test served as a surrogate for comfort. By improving its grip on the penis, patients can secure their penis with minimal clamping force, thereby improving comfort. Results Our literature search revealed that the average cost for PTDs recommended by urologists for patients with PD was approximately $883. Our PTD currently costs $6.38 to manufacture and assemble. We found a statistically significant (p=0.000276) increase in the tension-holding capacity of the silicone-lined clamp compared to that of the all-plastic clamp. This demonstrates that our silicone-lined clamp may exert less clamping force on the penis, thereby providing patients with the same stretching and a more comfortable grip. Conclusions Future directions include exploring urologists' perception of PTT for PD and their PTD recommendation patterns, refining our current PTD model, and clinically testing our device compared to those currently available. Disclosure No.

(169) New Findings Regarding the Degree of Penile Curvature Correction with IPP Alone

Abstract Introduction Inflatable penile prosthesis (IPP) insertion is an effective treatment for men with erectile dysfunction and Peyronie’s disease. Most literature on this subject focuses on the utility of adjunct curvature correction maneuvers after IPP placement. There has been little investigation regarding the degree to which the implant alone improves penile curvature prior to the implementation of adjunct curvature correction maneuvers. Objective The primary objective was assessing the impact of IPP on known penile curvature immediately after insertion. Secondary objectives were changes in penile curvature after adjunct curvature correction maneuvers and postoperatively. Methods This is an IRB-approved (IRB 00031589) retrospective series of all IPP patients with known preoperative penile curvature undergoing IPP placement with a single surgeon from January 2017 to June 2023. Extensive investigation of available patient chart information was conducted. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) ranging 16-24cm in length (mean 19.8 ± 1.9cm) with 0-3cm rear tips (mean 1.4 ± 0.9cm). Goniometer was used to assess curvature during preoperative intracavernosal injection and duplex Doppler ultrasound, at multiple points intraoperatively, and postoperatively at 2 weeks, 6 weeks, and 6 months. Biplanar curvatures were recorded as primary and secondary values. SPSS (IBM, Armonk, NY, UA) was used for statistical analyses, which included t-tests, chi-squared tests, and ANOVA. Results Sixty-one patients were included. Mean known primary preoperative curvature was 40° ± 16° (10 to 80°). IPP placement prior to adjunctive maneuvers resulted in 21° ± 10° absolute reduction in primary penile curvatures, corresponding to a 52% ± 26% improvement (50° reduction to 5° worsening). Dorsal curvatures improved by 21° ± 8° (51% ± 17%, 40° to 5° reduction) with IPP alone. Ventral curvatures improved by 24° ± 18° (49% ± 51%, 50° reduction to 5° worsening) with IPP alone. Lateral curvatures improved by 19° ± 10° (54% ± 24%, 40° to 0° reduction) with IPP alone. Eight patients had resolution of primary curvature with IPP alone, with mean preop curves 32° ± 11° (range 15° to 50°). Three of these needed modeling for secondary curvatures, leaving five total who did not require adjunct curvature correction maneuvers. Subsequent modeling for all patients resulted in 14° ± 9° absolute reduction in primary penile curvatures and up to 68% further improvement. Sample size precluded assessment of statistical significance among groups. Conclusions IPP placement appears to correct approximately 20° of penile curvature in this series, with similar effect on all curvature directions. These data may help clarify patient preoperative counseling and guide surgical planning. Further multicenter studies incorporating more patients and additional IPP types are warranted. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.

Grafts in Peyronie's surgery without the use of prostheses: a systematic review and meta-analysis.

Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.

A scoping review on chordee correction in boys with ventral congenital penile curvature and hypospadias.

Congenital penile curvature (PC), often concomitant with hypospadias, poses challenges in urology. Surgical correction techniques, including plication and corporotomy, lack standardized guidelines. This study aims to address the paucity of high-level evidence by comprehensively reviewing the outcomes of PC correction procedures in patients with and without hypospadias. This will inform clinical decision-making and provide insights for future research and meta-analyses. We conducted this scoping review in accordance with the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines. An extensive literature search was performed and comparative studies published in English up to June 2023 were included. The studies were divided into three categories: PC without hypospadias, PC with hypospadias, and studies comparing two or more materials for covering the ventral corporotomy. Data extraction comprised author details, patient characteristics, study design, interventions, outcomes, and complications. Methodological quality was assessed using the Newcastle-Ottawa Scale. Forty-two studies were included in the review, which collectively comprised 3180 patients. Thirteen comparative studies reported the outcomes of surgery for congenital PC without hypospadias, 22 studies compared different techniques of PC correction in patients with hypospadias and 7 studies compared the type of materials for coverage following ventral corporotomy. In cases of PC without hypospadias, the most commonly reported surgery was the Nesbit's plication. For PC with hypospadias correction, the results of ventral corporotomy were superior to that of dorsal plication in most of the studies. The two-stage repair had better results when compared to the one-stage repair for patients with perineo-scrotal hypospadias. In studies comparing materials for coverage of ventral corporotomy, the tunica vaginalis flap or graft was utilized most commonly. The majority of the studies reported a success rate ranging from 85% to 100%. The methodological quality was high in all but four studies. Plication procedures are generally preferred for PC without hypospadias, but they result in penile shortening. For those with hypospadias, corporotomy is associated with superior outcomes than plication, especially for those with severe curvature and redo procedures. For ventral corporotomy coverage, the tunica vaginalis flap or graft is the most commonly reported tissue in the literature.

Surgical efficacy of tubularized incised plate urethroplasty applying for Buck's fascia coverage in the treatment of hypospadias

ObjectiveThe aim of this study was to compare the effectiveness of Buck's fascia and dartos fascia in covering the neourethra during tubularized incised plate urethroplasty (TIPU) for treating hypospadias in children. MethodsWe conducted a retrospective analysis of 100 cases of hypospadias treated with TIPU at the Department of Urology, Beijing Children's Hospital from January 2019 to September 2021. The cases were divided into two groups (A and B) based on the type of intraoperative neourethral covering used during surgery. Group A (n = 53) was covered with Buck's fascia, while group B (n = 47) was covered with dartos fascia. Two experienced surgeons performed the surgeries in their respective groups. We recorded general clinical data, intraoperative measurements, and postoperative follow-up data for both groups and analyzed the results statistically. ResultsThere were no significant differences in clinical data, such as mean age, urethral opening position, penile length, urethral plate width, urethral defect length, preoperative penile curvature and follow-up time (P > 0.05) between the two groups. However, group A had a wider glans and a lower proportion of dorsal tunica albuginea plication to correct penile curvature but a higher proportion of 6F catheters left in place (P < 0.05). c, group A reported 12 cases (22.6 %) of complications including eight cases (15.1 %) of urethral stricture and five cases (9.4 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. On the other hand, group B reported 17 cases (36.2 %) of complications including three cases (6.4 %) of urethral stricture and fourteen cases (29.8 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. A multifactorial analysis incorporating confounding factors revealed a lower incidence rate for urethral fistulas in group A compared to group B(P < 0 0.05). ConclusionThe application of Buck's fascia to cover the new urethra can effectively reduce the incidence of urethral fistula in TIPU, and the quality of Buck's fascia and suture tension should be taken into account to avoid the formation of urethral strictures.

The Use of Vacuum Devices as Adjuvant Therapy before and after Penile Curvature Surgery in Patients Affected by La Peyronie's Disease: Results from a Comparative Study.

Peyronie's disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. All enrolled patients were assigned to the following groups: (a) the treatment group: VED treatment (three times per week) starting 3 months before surgery and (three times per week) one month after surgery; and (b) the control group: VED treatment (three times per week) one month after surgery. Follow-up urologic visits were scheduled for 3 and 6 months after surgery, and the two groups were compared. A total of 38 patients were enrolled (median age 67 years, 57-74, IQR): 20 in the treatment group and 18 in the control group. At the follow-up visits, the two groups were different in terms of IIEF-5 (26 vs. 24; p = 0.02), "yes" to SEP2 and 3 (85% vs. 55%; p < 0.001, 85% vs. 50%; p < 0.001, respectively), and PDQ (-16 vs. -11; p = 0.03). Complete correction of penile curvature was achieved in 36 patients (94.7%). In the treatment group, no hourglass deformity was reported, whereas one patient reported a mild hourglass deformity in the control group. In the treatment group, we obtained a longer total penile length (median +1.5 cm). The overall satisfaction rate was 98% in the treatment group and 96% in the control group. The VED treatment before penile curvature surgery in patients affected by PD was able to improve surgical outcomes.

Penile rehabilitation in patients following surgical treatment of Peyronie’s disease

Peyronie's disease (PD) is an acquired disease, which is based on a violation of the wound healing process, which results in the formation of fibrous plaques in the tunica albuginea of the cavernous bodies. The prevalence of erectile dysfunction (ED) among patients with PD ranges from 22% to 54%, according to various studies. Surgical treatment remains the "gold standard" for correcting penile curvature in PD. It is important to note that the existing methods of PD surgery (techniques with shortening or lengthening of the tunica albuginea) carry the risks of developing ED or aggravating its severity. At the same time, the absence of adequate sexual rehabilitation following PD surgery is associated with a significant deterioration in functional outcomes. In view of the above, the article is aimed to systematise information on penile rehabilitation methods in patients following PD surgery, which showed that the problem remains relevant to the present day. Most existing penile rehabilitation methods are currently not sufficiently investigated, and it is therefore impossible to give clear recommendations on the use of any method. The small number of well-designed and randomised studies on this problem is noteworthy, most likely due to the relative rarity of the disease.

Effectiveness of penile ventral curvature correction and the trend of hypospadias repair: a prospective study of the national center in China

BackgroundHypospadias repair is a complex surgical procedure that involves correcting penile ventral curvature (VC) and performing urethroplasty. This study aims to evaluate the effectiveness of different strategies for VC correction...

Treatment of penile curvature with aldehyde free bovine pericardium graft: an original and prospective evaluation of a cohort of patients with peyronie’s disease

Introduction: Peyronie´s disease (PD) is a common condition that can cause penile curvature and /or deformities and therefore affecting the male sexual function. The most effective treatment for clinically significative and stable penile curvature due to PD is the reconstructive surgery that involves techniques that do not shorten the penile length. Among the techniques that correct the curvature restoring the penile length, the incision and/or excision of the plaque, followed by the reconstruction of the defect with a graft remains as the gold standard. Although several materials have been used as a graft in the treatment of penile curvature due to PD, none have shown results good enough to be considered as the first choice. Herein, we aimed to evaluate the results of the surgical treatment of patients with penile curvature due to PD using a new biograft. Methodology: We performed the surgical management with graft technique in twelve men suffering from penile curvature due to PD. Penile curvature was measured before and one year after the reconstructive procedure. The graft of choice was the bovine pericardium graft segment treated with L-Hydro aldehyde-free technology. Erectile function was evaluated by the IIEF questionnaire and penis length was measured by a rigid rule during the pharmacological induced erection test. Results: The overall success rate of correction of the penile curvature was 90.9% and the patient’s satisfaction rate was 91.7%. No serious adverse events were found and erectile function impaired in 18.2%.There was an increase in penile length in 91.7% and this ranged from 0.7 to 3.0 cm. Conclusion: Correction of penile curvature due to Peyronie's disease using the technique of incision and/or excision of the plaque with the aldehyde-free bovine pericardium graft has high success rates in terms of both penile shaft rectification and patient satisfaction. L-hydro bovine pericardium graft is easy to handle surgically, allows a tight anastomosis and does not present serious postoperative complications. Furthermore, it can be used simultaneously with penile implants and appears to have a role in restoring penile length.

Do patients with Peyronie's disease perceive penile curvature in adults and children differently than the general population?

As perception of penile curvature varies widely, we sought to understand how adults perceive curvature and how these opinions compare with those of patients with curvature, specifically Peyronie's disease (PD). To investigate the perspectives of curvature correction from adults with and without PD, as well as differences within demographics. A cross-sectional survey was administered to adult patients and nonpatient companions in general urology clinics at 3 institutions across the United States. Men, women, and nonbinary participants were recruited. Patients were grouped as having PD vs andrology conditions without PD vs general urology conditions plus companions. The survey consisted of unlabeled 2-dimensional images of penis models with varying degrees of curvature. Participants selected images that they would want surgically corrected for themselves and their children. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to correct. Our main outcome was to detect differences in threshold to correct curvature between those with and without PD. Participants were grouped as follows: PD (n = 141), andrology (n = 132), and general (n = 302) . Respectively, 12.8%, 18.9%, and 19.9% chose not to surgically correct any degree of curvature (P = .17). For those who chose surgical correction, the mean threshold for correction was 49.7°, 51.0°, and 51.0° (P = .48); for their children, the decision not to correct any degree of curvature was 21.3%, 25.4%, and 29.3% (P = .34), which was significantly higher than correction for themselves (P < .001). The mean threshold for their children's correction was 47.7°, 53.3°, and 49.4° for the PD, andrology, and general groups (P = .53), with thresholds no different vs themselves (P = .93). On multivariable analysis, no differences were seen in demographics within the PD and andrology groups. In the general group, participants aged 45 to 54 years and those who identified as LGBTQ (lesbian, gay, bisexual, transgender, queer) had a higher threshold for correction as compared with their counterparts when factoring other demographic variables (63.2° vs 48.8°, P = .001; 62.1° vs 50.4°, P = .05). With changing times and viewpoints, this study stresses the importance of shared decision making and balancing risks and benefits to correction of penile curvature. Strengths include the broad population surveyed. Limitations include the use of artificial models. No significant differences were seen in the decision to surgically correct curvature between participants with and without PD, with participants being less likely to choose surgical correction for their children.

(510) Do Patients with Peyronie’s Disease Perceive Penile Curvature Differently than the General Population?

Abstract Introduction Perception of penile curvature (PC) varies widely, and correction of PC is in the eye of the beholder. Objective We sought to investigate if patients with Peyronie’s Disease (PD) had differing opinions on correction of PC compared to general andrology (AD) patients without PD and general urology (URO) patients. Methods A cross-sectional survey was administered to adult patients in andrology and general urology clinics at 3 geographically separate institutions. Patients were grouped with having PD vs AD vs URO conditions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction. Results Ninety-four PD, 106 AD, and 302 URO patients were recruited. When comparing the 3 groups, besides obvious gender differences with PD patients, PD patients were less in 25-34 age range and more in 55-64 age range (p=0.01 and p=0.007). PD was less represented in Mid-Atlantic (p&amp;lt;0.001). 8% of PD, 12% of AD, and 20% of URO patients chose not to surgically correct any degree of PC (p=0.001). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 52.5° (SD 13) for PD, 37.2° (SD 29.5) for AD, and 51.0° (SD 19.9) for URO patients. When comparing PD patients with AD patients, no difference in the decision to surgically correct was found (p=0.42). This was also found to be the case when comparing PD with URO (p=0.46) and PD+AD patients vs URO (p=0.67). On univariable analysis, among AD patients, those ages 55-64 were more willing to undergo PC correction at lower degrees of PC (p=0.03) but did not hold up on multivariable analysis (p=0.40). No other demographic factors among PD and AD groups were found to have an impact on willingness to undergo PC correction (Table 1). Conclusions No significant differences were seen in the decision to surgically correct PC when comparing the perspectives of patients with PD, AD, and URO. Roughly 10% of all of these patients would defer on surgical management of any degree of PC. Despite having PC, no demographic differences were seen among PD patients’ willingness to correct PC. Disclosure No

(104) A Multicenter Evaluation of Penile Curvature Correction in Men with Peyronie’s Disease Undergoing Inflatable Penile Prosthesis Placement

Abstract Introduction Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie’s Disease (PD) and significant erectile dysfunction (ED). Adjunctive procedures such as modeling, plication, or incision/excision and grafting can be used when there is residual curvature after IPP placement. Objective To evaluate the management of curvature correction in patients with PD undergoing IPP among high-volume prosthetic urologists. Methods We performed a retrospective study of 205 patients diagnosed with PD undergoing IPP by 7 high volume penile prosthetic surgeons. Demographic, intraoperative, and postoperative data were collected and analyzed. Descriptive statistics were performed using mean and standard deviation for continuous variables, while incidence and percentages were used for categorical variables. We calculated the mean change in penile curvature after IPP insertion for each of the adjunctive correction techniques. Intra- and post-operative complications were collected. Results 205 patients met inclusion criteria with a mean age of 60.7 years (SD=9.2) and a median follow-up of 6 months (0.5-58.5 months). The mean preoperative curvature was 43.4° (SD=18.9°) with dorsal curvature being the most common. Overall, 73 (35.60%) patients had IPP only with no adjunctive curvature correction procedure, 24 (11.70%) underwent plication, 10 (4.90%) underwent grafting, and 98 (47.80%) underwent modeling. Preoperatively, the mean starting curvature was 35.7° for the IPP-only group, 48.1° for the plication group, 60.6° for the grafting group, and 46.0° for the modeling group, p&amp;lt;0.001. Patients undergoing grafting had significantly fewer comorbidities compared to the other groups: only 1 (10%) had diabetes and none were smokers or had cardiovascular disease, p&amp;lt;0.001. After penile curvature correction, the mean curvature change was 25.5° for the IPP-only group, 40.0° for the plication group, 55.0° for the grafting group, and 35.0° for the modeling group, p &amp;lt;0.001 (Figure 1). Intraoperatively, proximal perforation occurred in 2 (0.96%) patients, managed by a rear tip extender sling. Post-operatively, there were 33 (16.10%) non-infectious and 4 (1.90%) infectious complications. There was no significant difference in complications between groups. Conclusions Although incision/excision and grafting seem to provide the greatest penile curvature correction for PD patients undergoing IPP placement, this adjunctive correction procedure is less commonly performed among high volume prosthetic urologists. Our results suggest grafting is reserved for patients with greater preoperative curvature and fewer preoperative comorbidities. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma: SpeakBoston Scientific, Clarus Therapeutics, Coloplast, Cynosure, Promescent, Sprout, Viome, Hims &amp; Hers Health, Inc.

(481) Experience with Plaque Excision and Dermal Grafting in the Surgical Treatment of Peyronie's Disease

Abstract Introduction Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature, several surgical options to treat PD have been performed. Surgical treatment use graft, as these procedures aim to maintain penile length. Objective To assess outcomes following plaque excision and dermal grafting in the surgical treatment of Peyronie's disease. Methods A prospective study, was performed at Binh Dan Hospital (Ho Chi Minh City – VietNam), from 1/2016 – 12/2020. Surgical correction for curvature is indicated when the PD duration is &amp;gt;12 months, and when the stable phase of PD is &amp;gt;6 months, all case use plaque excision and dermal grafting technique. Results our study have 52 patients, - History illnes: 42.1% diabetes, 26.3% hypertension, 36.84% hyperlipid. - Age mean: 58.31 ± 8.5 years (min: 48 – max 72). - Chief complaine: penile deformities (36.8%), pain (31.6%), palpable lumps (26.3%). - 52.6% have psychological effects. - Fibrous plaque on corpus: Anterior (5.2%), Mid (47.37%), Posterior (47.37%). - Plaque size: 72.59 ± 75.78mm2 (15.51 mm2 – 207 mm2). + Primary outcome measures - Complications (follow one month): alter sensation (16.7%), edema (21.05%), infection (1.9%), pain (10.53%) - Penile straightening: 89%. - Penile length: no changes (82.7%), shorter (17.3%). + Secondary outcome measures - Recurrent curvature: 3 cases – 01 case need operation second time. - Post-operative erectile dysfunction: 7 cases (13.46%). - Patient satisfaction: 82.3% Conclusions Surgical correction of penile curvature is the mainstay for PD treatment. Dermal graft: effectiveness in terms of satisfaction, length change, straightening, economic efficiency and complications. Suitable for patients with underlying medical conditions. Adequate preoperative patient counseling. Disclosure No

Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie's disease patients.

With the advent of new surgical techniques to treat Peyronie's disease with concomitant erectile dysfunction, there remains a question of whether manual modeling (MM), an older technique, still has a place in the treatment algorithm within penile prosthesis (PP) surgery. While the implantation of a PP often corrects moderate to severe curvature, penile curvature can remain greater than 30°, even when concurrent MM is performed during prothesis implantation. There are new variations of the MM technique that have been recently utilized in the intraoperative and postoperative setting to achieve penile curvature less than 30° when the implant is fully inflated. The inflatable PP, regardless of the specific model of choice, is preferred over the noninflatable PP when utilizing the MM technique. MM should be the first line of treatment for persisting intraoperative penile curvature after the placement of a PP due to its long-term efficacy, noninvasive approach, and significantly low risk of adverse effects.