Penile Deformity Research Articles

Vacuum Erection Device Plus Once-Daily Tadalafil Improve Clinical Outcomes after Extracorporeal Shock Wave Therapy in Men Affected by Erectile Dysfunction Associated with Peyronie's Disease.

The purpose of this study is to examine the combination of the mechanical effects of penile therapy with vacuum erection devices (VEDs) plus PDE5i, which improve clinical outcomes after extracorporeal shockwave therapy (ESWT) in men affected by erectile dysfunction (ED) associated with Peyronie's disease (PD). A total of 153 medical records of patients affected by PD in stable stage with ED and treated with ESWT were divided into two groups. Group A (GA) included 72 men treated with ESWT, mechanical stretching with VEDs and PDE5ì (Tadalafil 5 mg), and Group B (GB) included 81 men who received only ESWT plus Tadalafil 5 mg with the same protocol of GA. The patients in both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size, and penile curvature. The results were evaluated at baseline and 3, 6, and 12 months after the treatments. Three months after the treatment, GA patients had a reduction in penile curvature degree from a mean ± SD of 33.91 ± 8.34° at baseline to a mean ± SD of 19.46 ± 7.15° after 12 months, whereas pain in an erection or during intercourse was resolved completely in 88.9% of the patients. The mean ± SD IIEF-15 score of patients affected by severe/moderate ED further improved significantly in the GA group (p < 0.001) after 3, 6, and 12 months of treatment. There were no permanent adverse sequelae after treatments. The regular use of a VED plus Tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity, pain, and erectile function.

Creation of a Novel Classification System (PTNM) for Peyronie's Disease and Penile Curvature Using Evidence-Based Criteria.

Our goal was to identify new Peyronie's disease (PD) subtypes, non-PD penile curvature classifications, and define active (acute) vs stable (chronic) phases of disease using evidence-based analyses. A retrospective review was performed of 1098 men who presented with penile deformity, including subjective standardized and nonstandardized questionnaires and objective measures. A second cohort of 719 men who were sent a mailed survey was also utilized for the relapsing/remitting subtype. Statistical analyses were performed to identify clusters of disease characteristics representative of distinct PD and non-PD categorizations, including sensitivity/specificity analyses and subtype comparisons. Comparative analyses identified 4 distinct subtypes of PD: (1) classical and nonclassical, (2) calcifying-moderate/severe calcification, (3) progressive-subjective worsening following disease onset, and (4) relapsing/remitting-reactivation following ≥ 6 months of stability. Additional, non-PD categorizations included congenital (lifelong), maturational (developed around puberty), and trauma induced. Statistical analyses demonstrated unique profiles among each category. Penile pain was not found to be a reliable predictor for disease progression or stability. Stable phase disease (historically "chronic") was variably defined by subtype: classical (≥3 months); progressive, calcifying, or trauma induced (≥12 months + ≥3 months stable OR ≥6 months stable). Similarly, PD subtypes may be assigned at ≥ 3 months following disease onset. A PTNM staging system is proposed to help communicate disease states, in which P = PD component (Ca-calcifying, Cl-classical, P-progressive, R-relapsing/remitting, U-undifferentiated), T = trauma component (0-absent, 1-present), N = non-PD component (C-congenital, M-maturational, U-undifferentiated), and M = mode (0-stable, 1-active); for example, PClT1N0M0 = stable classical PD with prior trauma. The current study provides an evidence-based proposal for the establishment of new PD subtypes and non-PD curvature categorizations as well as a standardized definition for active vs stable phases of disease.

Intralesional and topical treatments for Peyronie's disease: a narrative review of current knowledge.

Peyronie's disease (PD) presents a multifaceted challenge in contemporary urological practice, marked by penile deformity, pain, and the potential for erectile dysfunction. We meticulously explored the existing literature of intralesional/topical interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive PD management. To conduct this review, we performed a systematic search using the PubMed, Scopus, and ScienceDirect databases, including the keywords of combination of the "Peyronie's disease/plastic induration of the penis (PIP) and intralesional/topical treatments". The study selection was based on adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in the inclusion of 16 articles. We delve into the effectiveness and safety profiles of collagenase Clostridium histolyticum (CCH), interferon, platelet-rich plasma (PRP), hyaluronic acid, botulinum toxin, stem cell, extracorporeal shock wave therapy (ESWT), and traction therapy, assessing their impact on penile curvature, length improvement, and patient-reported symptoms and outcomes. The best options evaluated are intralesional injections of CCH and penile traction devices, alone or in combination. Despite PD remains a challenge for urologists, the objective of this review is to contribute to the evolving landscape of PD management, fostering informed decision-making, and personalized care for individuals grappling with this challenging condition.

Report of climacturia and orgasmic disorders after radical prostatectomy in a Brazilian tertiary hospital: shedding light on a neglected condition.

After radical prostatectomy (RP), it is rarely acknowledged that several sexual dysfunctions can arise. These include issues in the orgasmic domain (e.g., decreased orgasm intensity, dysorgasmia), problems with ejaculation (e.g., absence of ejaculation), the development of penile deformities, and low sexual desire. This article aims to report the occurrence of orgasmic and ejaculatory dysfunction when actively investigated, documenting those rates and characterizing specific features of these conditions following RP. This study has analyzed retrospective data from men who underwent RP and were experiencing erectile dysfunction. During a structured visit, patients were systematically questioned about dysorgasmia, altered orgasmic sensation, climacturia, and arousal incontinence. Continuous variables were analyzed using the Student T or ANOVA tests, while categorical variables were analyzed using Chi-squared or Fisher's exact tests. The associations were described as odds ratios with precise confidence intervals. All tests were two sided; a p value < 0.05 was considered statistically significant. Sixty patients were included, out of which 3 (5%) reported dysorgasmia, while 33.3% presented a decrease in orgasm intensity. Climacturia was reported as the most common orgasmic disorder in 40 (66.6%) patients. However, only 14 patients (35%) reported that it frequently occurs, i.e., more than half of the time. Among the patients who reported climacturia, 72.5% classified it as mild losses. Additionally, arousal incontinence (AI) was noted in the study by 19 (26.3%) patients. Our study highlights the importance of discussing orgasmic dysfunctions after RP, which can be frequent and bothersome but are often overlooked in preoperative counseling.

Acute Phase Peyronie's Disease: Where Do We Stand?

Peyronie's disease (PD) is a common benign condition characterized by superficial fibrosis and scar formation at the tunica albuginea of the penis, eventually leading to penile curvature. It is believed that penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease. Routinely, PD is divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the former. Surgical intervention should be avoided during the acute phase, as the risk of recurrence or progression of penile deformity during this stage might affect the optimal outcomes of the procedure. During this stage, many conservative treatment options have been suggested, including oral, topical, and intralesional therapies, extracorporeal shock wave therapy (ESWT), and penile traction therapy (PTT). Currently, the optimal treatment consists of a combined treatment strategy with phosphodiesterase type 5 inhibitors (PDE5Is), ESWT for pain management, PTT, and intralesional therapies. Large, well-designed randomized controlled trials (RCTs) are necessary to further elucidate the most efficient treatment option for acute phase PD.

Early-onset and uncontrolled diabetes mellitus factors correlate with complications of Peyronie's disease.

Peyronie's disease (PD) is a connective tissue disorder that affects the penis and is characterized by abnormal collagen structure in the penile tunica albuginea, resulting in plaque formation and penile deformity. PD's overall prevalence is estimated at 3.2% to 8.9%, with rates as high as 20.3% among men with type 2 diabetes mellitus (DM). However, the characteristics of DM associated with PD complications remain unclear. To explore clinical associations between DM characteristics and PD complications. We conducted a retrospective analysis of patients with DM and PD who presented at our institution between 2007 and 2022. We examined patients' clinical histories, DM- and PD-related clinical parameters, and complications. Penile deformities were assessed through physical examination, photographs, and penile Doppler ultrasound. Patients were categorized into subgroups based on age of DM onset: early (<45years), average (45-65years), and late (>65years). Outcomes included effects of DM characteristics on PD development, progression, and severity. In total, 197 patients were included in the evaluation. Early-onset diabetes and elevated hemoglobin A1c (HbA1c) levels exhibited significant correlations with the early development of PD (ρ = 0.66, P < .001, and ρ = -0.24, P < .001, respectively). Furthermore, having DM at an early age was associated with the occurrence of penile plaque (ρ = -0.18, P = .03), and there were no significant differences in plaque dimensions (ρ = -0.29, P = .053). A rise in HbA1c levels after the initial PD diagnosis displayed positive correlations with the formation of penile plaque (ρ = 0.22, P < .006). These findings emphasize the need for comprehensive assessments and personalized treatment strategies for individuals with DM and PD. Enhanced management approaches can improve outcomes for those facing both challenges. Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, and challenges in controlling confounding variables. This study highlights that early-onset diabetes and poor diabetes control, as indicated by a subsequent rise in HbA1c levels following PD diagnosis, are significantly correlated with the onset and severity of PD. Revealing the mechanisms behind these findings will help us develop better management strategies for individuals with DM and PD.

Clinical Presentation of Peyronie's Disease: A Retrospective Study of 564 Cases.

Peyronie's disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious-depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of "significant anxiety" (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence.

Extratunical grafting for minimally invasive management of complex Peyronie's disease deformities.

Penile deformities due to Peyronie's Disease (PD) often significantly impair men's sexual health and quality of life. In this article we discuss the extratunical graft (ETG) procedure as a management strategy for PD patients with hourglass or indent penile deformities. We compiled descriptions of surgical techniques and performed a review of the literature regarding ETG for PD. The ETG procedure appears to have promising results in the management of indent/hourglass deformity of PD. The findings of this review of the literature demonstrate that ETG is a safe and effective reconstructive technique for penile deformity with minimal side effects. We recommend utilizing ETG with or without plication for PD patients with indent or hourglass deformities. Strengths of ETG are the improvement in patients with tunical indents and hourglass deformities secondary to PD. Additionally, patients who underwent ETG maintained sexual function given no significant change in penile length and intact erectile function. Limitations, however, are that the procedure is relatively new, and data are limited to small cohorts. The ETG procedure is a safe and effective for management of complex PD in the short- and intermediate-term follow-up cohort.

Minimally invasive method of surgical treatment of Peyronie's disease

Objective. To improve the results of surgical treatment of Peyronie's disease. Materials and methods. 20 patients with Peyronie's disease aged 22 to 60 were treated in the urological departments of the Private Clinical Hospital “Russian Railways Medicine” and Astrakhan City Clinical Hospital No. 3 named after. C.M. Kirov. A method of surgical treatment of Peyronie's disease using a shortening technique without opening the tunica albuginea includes the application of a pressure tourniquet to the base of the penis, puncture of the cavernous bodies, injection of sterile saline into them until an erection is achieved, determination of the angle of curvature of the penis, removal of the tourniquet and surgery to eliminate curvature of the penis. Results. Neither postoperative complications nor formation of hematomas were observed. The patients were discharged on the 4th day in satisfactory condition. 1.5 years` observation showed no progression of angular deformation of the penis which could impede sexual intercourse. The mobility of the skin of the penis was preserved. Conclusions. In addition to the correction of penile deformity, our method eliminates the need for extensive incisions and preserves the physiological functions of the penis. As a result of using this surgical method, the following goals are achieved: minimal trauma to tissues in the surgical area, absence of scar processes in the plastic area and preservation of the skin of the penis mobility, absence of pronounced postoperative tissue edema, no need to drain the wound, reduction of the duration of the operation and minimal blood loss, short postoperative and rehabilitation period.

Tinjauan Literatur Penyakit Peyronie Tentang Penanganan Penyakit Peyronie

Peyronie's disease is a sexual disease or medical disorder where the clinical manifestation is penile deformity in the form of penile curvature that occurs in 0.5-20.3% of the male population and is characterized by fibrotic plaques in the tunica albuginea. Aim: To provide information obtained from the literature review process. Methods: Literature search using the keyword 'Peyronie's disease and treatment' in PubMed.

Use of Himplant® for correction of residual deformity following prior treatment of peyronie's disease: a case series.

Over the years, numerous non-surgical and surgical treatment options have been explored for Peyronie's disease. Current options may result in incomplete correction of the deformity, which can be bothersome to the patient. This is a two-center case series of three patients who had previously undergone treatment for Peyronie's disease. Patient 1 underwent plication with extratunical grafting. Patient 2 underwent a series of Xiaflex® injections and then subsequent surgical plication for residual curvature. Patient 3 underwent a series of Xiaflex® injections. The Himplant® subcutaneous silicone penile prosthesis was placed in a standardized manner through a scrotal incision in all cases to mask residual penile deformities and enhance penile girth after Peyronie's disease treatment. Patients were contacted and asked 18 questions regarding satisfaction and erectile function with the responses recorded. This pilot study presents findings of high patient satisfaction, increases in flaccid penile length and girth, and an acceptable profile of adverse events following Himplant® placement. Based on our limited experience, we would consider offering Himplant® implantation when residual curvature is <40° and the penile indentation does not cause instability/buckling during penetrative sexual activity. Further research and larger studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

(186) Modified Extra-Tunical Grafting for Peyronie's Disease Associated Indentation Deformity

Abstract Introduction Peyronie’s disease is characterized by penile plaque or scar within the tunica albuginea. This results in penile deformity, most commonly penile curvature but also volume loss deformity such as hourglass or indentation. This volume loss occurs in up to 65% of men with Peyroine’s disease. Surgical management for patients with significant deformity includes plaque incision/partial excision and penile grafting with an absorbable grafting material. In the original description of extra-tunical grafting, the grafting material was placed over Buck’s fascia via a ventral longitudinal incision. In our modified technique, the grafting material is placed under Buck’s fascia and superficial to the tunica albuginea, which allows the grafting material to be less palpable in the flaccid condition. Objective To demonstrate a modified approach to Extra-Tunical Grafting for peyronie’s disease indentation deformity. Methods Intra-operative video of modified extra-tunical grafting was recorded with an overhead surgical camera. Results Successful modified extra-tunical grafting with excellent penile straightening and restoration of penile girth and minimal palpability of the graft. Conclusions Our modified extra-tunical grafting technique is a reasonable option compared to the standard grafting technique Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

(117) Interrater Agreement and Feasibility of Three-Dimensional Photography for Curvature Assessment in Peyronie's Disease

Abstract Introduction Curvature assessment is an iterative aspect of the evaluation of Peyronie’s Disease (PD); its accuracy is subject to patient erection quality and clinician technique. Prior studies have shown promising results when using 3D modeling software in curvature assessment, yet none have applied the technology to human subjects with complex PD in an authentic clinical scenario. Objective To evaluate the feasibility of using 3D modeling to assess penile deformity in PD patients. Methods MirrorMe3D is a HIPPA-compliant iOS mobile and web-based platform designed for 3D anatomical modeling. 2 trained urology fellows (coders 1 and 2) were trained to create models using the app by acquiring ≥ 12 images of the target obtained in a multiplanar, 360-degree fashion. Participants verbally consented to deidentified penile photography during their clinic visit for penile curvature assessment with Doppler ultrasound (CADUS). Photographs were obtained prior to performing DUS with the patient in the supine position and using a commercially available clip-on ring light and custom 3D-printed holder device placed over the penis base for stabilization. 3D models were generated upon completion of the visit and screened for quality. Curvature assessment on the 3D images included curvature direction, location, degrees, and other defects identified via visual inspection of the digital model. Results 7 unique, quality 3D images were generated using 15-20 photos per participant (Figure 1). The time required to obtain images was 1-2 minutes. Once the 3D image was developed, the curvature assessment took about 5 minutes. Quantitative results are summarized in Table 1. We observed a high rate of agreement in terms of primary direction of curvature and an acceptable variance rate when evaluating degrees of curvature within a margin of 10°; of note, coders were in agreement with each other to within a 10° margin 100% of the time (7/7 patients). We also observed a high agreement rate when evaluating the presence of absence of tapering but low agreement when assessing for the presence of indentation and hourglass deformity. Regarding the penis stabilizer, our experience suggests that it may alter the base of the penis anatomy, but it improves capture of the organ with diminished interference from surrounding anatomy (scrotum, abdomen). Factors influencing the quality of the image were exam room set-up, patient anxiety about losing an erection, lighting, and body hair. Conclusions 3D image-based PD assessment can be implemented with minimal impact to visit efficiency. The 3D technique does not appear to reproduce complex PD measurements obtained by CADUS; however, future studies will evaluate the utility of employing this technology to a larger cohort and also to monitor treatment effect in complex PD patients. Disclosure No.

(119) Impact of Ethnicity on Clinical Outcomes of Intralesional CCH in Peyronie's Disease Patients Across Kaiser Permanente Southern California Database

Abstract Introduction Intralesional CCH injection is an effective treatment for Peyronie’s disease (PD) that utilizes collagenolytic enzymes to break down collagen plaque, thus reducing the penile deformity. The IMPRESS I and II clinical trials demonstrated efficacy of CCH in a predominant Caucasian population of men (95.8%). Little is known about treatment efficacy in the non-Caucasian population. Objective Using Kaiser Permanente’s ethnically diverse database, we sought to study the impact of race on CCH treatment outcomes. Methods This study examined the efficacy of intralesional CCH injection in a large healthcare system over 15 years. We defined treatment efficacy as percent change in penile curvature abnormality from baseline after a maximum of 4 treatment cycles. Impact of comorbidities on CCH efficacy was also examined. Patients with ventral curvature or initial curvature &amp;lt;30 ̊ or &amp;gt;90 ̊ were excluded from analysis. Standard statistical analysis was performed. Results 112 patients underwent CCH therapy and were included in this analysis. 46.4% of men completed all 4 cycles. Among men who received CCH, 66.1% were Caucasian, 22.3% Hispanic, and 9.8% African American. For co-morbidities, 87.5.% of men were not diabetic, while 22.3% of men had erectile dysfunction. The mean baseline pre-injection penile curvature was 51.63 degrees (range was 32-87 degrees). Caucasian men had the largest treatment response to CCH (45.6% decrease in penile curvature) compared to African American men (43.7%) and Hispanic men (40.5%), p = 0.9554. Non-diabetic men had a larger treatment response to CCH (44.9% decrease in curvature versus 39.3% in diabetics, p = 0.4726). Younger Men (age 18-44) also experienced a greater treatment response compared to other age groups (57.9% reduction in curvature, p = 0.171). There was a significant difference in number of cycles completed across different ethnicities (p = 0.0220). Hispanic men were significantly less likely to complete all 4 cycles of CCH compared to Caucasian and African American men (p=0.0004). Only 28.2% of Hispanic men completed all 4 treatment cycles. 48% of Hispanic patients report the need of language interpretation services during health appointments. Conclusions This is the largest post-market analysis of CCH treatment outcomes in a racially diverse PD population. Caucasian men had a greater treatment response after CCH injection possibly due to higher rate of completing all 4 treatment cycles. Nondiabetic men and younger men (aged 18 to 44) also had a greater treatment response after CCH injection. Hispanic men were significantly less likely to complete 4 cycles of injection therapy; possible explanations include language barriers. Future study is needed to determine if patient resources prepared in Spanish can improve treatment outcomes in Hispanic men with PD, and reduce these health care disparities observed in our study. Disclosure No.

(174) Use of Penuma® for Correction of Residual Deformity following Previous Treatment of Peyronie’s disease: Case Series

Abstract Introduction Over the years, numerous treatment approaches have been explored for Peyronie's disease (PD) including non-surgical and surgical options. Nevertheless, the current options are largely insufficient in effectively correcting residual penile deformities after treatment. Objective To evaluate the efficacy of utilizing the subcutaneous silicone penile prosthesis (Penuma®) as a treatment modality for correcting residual penile deformity, including curvature and indentation, and providing penile girth enhancement post-PD treatment. Methods This is a two center case series of three patients who had previously undergone various treatments for PD. Detailed data about these patients were collected including their demographics, PD characteristics, previous treatments, and outcomes (see table). These patients previously had different treatments including non-surgical i.e. Xiaflex® and/or surgical options i.e. plication procedure. The placement of Penuma® subcutaneous silicone penile prosthesis was performed in a standardized manner across all cases. Follow-up evaluations were conducted to assess the effectiveness of the procedure and any associated complications. Results The main findings of the study revealed successful correction of residual penile deformity (curvature, indentation, narrowing) as well as significant improvement in penile girth in all three cases following the placement of the Penuma® subcutaneous silicone penile prosthesis. The procedure resulted in improved sexual function and satisfactory aesthetic outcomes as reported by patients. No major complications were observed during the follow-up period. Conclusions Our case series demonstrates the potential effectiveness and benefits of using Penuma® to correct residual penile deformity and to provide penile girth enhancement in patients post-PD treatment. At this time, we would consider offering Penuma® implantation when residual curvature is less than 30 degrees and indentation does not cause any instability or hinge-effect during penetrative sexual activity. Further research and larger case studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: IMD.

Diagnosis and Management of Peyronie's Disease: A Clinical Consensus Statement and Recommendations from the Korean Society for Sexual Medicine and Andrology.

Peyronie's disease is an acquired condition characterized by penile deformities caused by fibrosis of the penile tunica albuginea, leading to symptoms such as penile pain, erectile dysfunction, and other associated issues. Despite extensive research, the pathophysiology of this condition remains poorly understood, and standardized diagnostic and treatment protocols are lacking. While clinical guidelines from several professional societies exist, they do not consistently account for factors such as patient ethnicity, geography, and socioeconomic status. Thus, the Korean Society for Sexual Medicine and Andrology (KSSMA) aimed to develop recommendations tailored to clinical practice in Korea. These recommendations summarize the latest evidence, including clinical practice guidelines from various international professional societies, and represent the consensus opinion of an expert group within the KSSMA. They encompass all aspects of Peyronie's disease, including the definition, diagnosis, non-surgical interventions, and surgical treatment options.

Surgical correction of congenital megaprepuce: a pilot study.

Congenital megaprepuce (CMP) is a rare penile deformity that usually requires surgical correction. This study was performed to examine the efficacy of the modified Sugita procedure for repairing CMP in pediatric patients. We retrospectively analyzed the clinical data of pediatric patients with CMP treated by a surgeon using the modified Sugita procedure in our hospital from January 2019 to April 2021. Twenty patients were enrolled, and their median age at surgery was 70.5 months (range, 60-96 months). All surgeries were successful, and no complications occurred during the operation. The postoperative foreskin had moderate edema in five patients, and soaking in 10% hypertonic saline resulted in disappearance of the edema within 4 to 8 weeks. The follow-up duration was 6 to 20 months (median, 10 months). No other complications occurred, such as dehiscence or hematoma. The modified Sugita procedure for correction of CMP produces excellent cosmesis and a low complication rate. Our study indicates that the modified Sugita procedure is a safe and feasible treatment option.

Unraveling the Complexity of Peyronie's Disease: A Comprehensive Exploration

Peyronie's disease (PD) stands as a distinctive pathology within the realm of urology, presenting a multifaceted clinical panorama characterized by the development of fibrous plaques in the tunica albuginea of the penis. Named after the 18th-century French surgeon François Gigot de la Peyronie, this disorder engenders penile deformities, pain, and psychological distress, underscoring the need for a nuanced understanding and comprehensive management approach. This article endeavors to provide an exhaustive exploration of PD, delving into its intricate etiology, pathophysiological underpinnings, clinical manifestations, and the far-reaching implications on psychosocial well-being. The disease's genesis intertwines genetic predispositions, microtrauma during sexual activity, and inflammatory responses, culminating in dysregulated wound healing processes marked by the excessive deposition of collagen. From a clinical standpoint, PD transcends beyond its physical manifestations, adversely impacting patients' mental and emotional states. The altered penile morphology and compromised sexual function pose not only physical challenges but also unravel a complex tapestry of psychological consequences. As such, this article scrutinizes the dual facets of PD, advocating for a holistic approach that addresses both the physical and psychosocial dimensions of the disease. Diagnostic modalities, ranging from clinical evaluation to imaging techniques, form a pivotal aspect of our discourse, providing clinicians with a comprehensive armamentarium for accurate and timely diagnosis. Moreover, an exhaustive review of treatment modalities, encompassing conservative measures, pharmacotherapy, and surgical interventions, aims to distill evidence-based insights guiding therapeutic decision-making. This comprehensive analysis seeks to contribute substantively to the existing body of knowledge, fostering a deeper understanding of PD within the medical community. By amalgamating clinical insights with emerging research trends, this article endeavors to illuminate the path toward refined diagnostic strategies and novel therapeutic interventions, ultimately striving for improved patient outcomes and an elevated standard of care in the management of Peyronie's disease.

Long-term outcomes after plaque excision grafting for Peyronie's disease and subanalysis of patients who undergo the procedure despite preoperative counseling against it.

Plaque excision and grafting (PEG) has been recommended for patients with Peyronie's disease (PD) with >60° curvature and/or hinge effect and strong preoperative erections, while placement of an inflatable penile prosthesis (IPP) is recommended when rigidity is suboptimal. Nevertheless, many patients counseled to undergo an IPP decline and insist on proceeding with PEG due to personal preference or desire to avoid an implant. We aim to review long-term outcomes in patients who underwent PEG for PD at our institution and investigate whether there is any difference in long-term outcomes in patients who undergo PEG despite a recommendation to undergo IPP. We conducted a retrospective chart review from 2007 to 2021 on PEG surgery performed at a single tertiary care institution in patients ≥18years old who had >3months of follow-up. Postoperative information was gathered from the electronic medical record, including postoperative erectile function, patient satisfaction, and the ability to engage in penetrative sexual intercourse. An overall 251 patients underwent PEG with a median follow-up of 12 months (IQR, 6-54). Among these, 54 (22%) were initially advised to undergo IPP but elected for PEG. Patients who underwent PEG despite counseling to undergo IPP reported lower postoperative ability to engage in intercourse (51% vs 76%). Seven (13%) patients initially advised to undergo IPP eventually received an IPP, relative to 7 (4%) initially advised to undergo PEG. Thorough preoperative assessment of erectile function and penile deformity can guide clinician counseling and manage patient expectations during decision making between PEG surgery and IPP implantation for PD. Limitations of this study include its retrospective nature, high attrition to follow-up, and risk of recall and selection bias. This is a large study with a median follow-up of 12months, with a high-volume single surgeon who treats patients in a specialized population of complex cases. Patients who were initially counseled to undergo IPP due to suboptimal erectile rigidity but elected for PEG had worse postoperative ability to engage in penetrative intercourse, and a higher proportion of these patients eventually received an IPP.

Penile fracture: a case series of 18 patients

Introduction: Penile fractures are a rare urological emergency. It is defined as ‘rupture of the tunica albuginea of one or both corpora cavernosa. The corpus spongiosum and the urethra may also be involved in this process.’ The tunica albuginea is stiff and significantly thinner during erection than in the flaccid state, which is when injury generally happens. Method: This case series was completed between January 2018 and January 2023 at the Department of General Surgery. Eighteen patients suspected of having penile fractures participated in were included this study. All patients were thoroughly evaluated upon hospital admission to identify the diagnosis, length of time since the accident, the site of the fracture, the extent of the penile hematoma, occurrence of blood at the external meatus, presence of urine retention, and intraoperative outcomes. Results: The patients were between the ages of 24 and 70, with a mean age of 37. The duration before the presentation ranged from 7 h to 1 month (the median was 22 h). Sexual intercourse was the cause in 12 (66%) cases, rolling in the bed in three cases (16%), and blunt trauma in three cases (kicking and the edge of the bed) (16%). Pain and swelling were present in all of the patients. In 15 patients (or 83%), there was evidence of penile deviation. At presentation, 15 (72%) patients reported experiencing rapid detumescence, discomfort, and penile swelling after hearing a cracking (popping) sound. None of these individuals experienced urine retention or urethral hemorrhage, and all were emptied on their own following the episode. Physical examination showed penile ecchymosis, swelling, and substantial discomfort when the penile shaft was examined. All but three patients had an evident penile deformity. Surgery was performed under spinal anesthesia in 14 (77.7%) patients. Four patients with a delayed presentation (more than 1 week) were managed conservatively. Conclusion: As a true urologic emergency, penile fractures should be treated immediately to reduce pain and swelling and ensure better functional and esthetic outcomes. Despite taking more time, a subcoronal circumcising degloving incision is the ideal method because it is exploratory and esthetically pleasing.