Penile Shortening Research Articles

Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie's curvatures.

Collagen fleece grafting (CFG) is the recommended treatment for severe Peyronie's disease (PD) curvature (> 60°), but its efficacy in mild/moderate curvatures remains uncertain. This study evaluated CFG in patients with mild/moderate curvatures (< 60°) at risk of penile shortening or symptomatic plaque. A retrospective review was conducted on patients who underwent surgical treatment for PD using plaque incision or partial plaque excision and CFG. Clinical parameters and complications were reviewed. Subgroup analysis was performed on patients with curvatures of > 60° and curvatures ≤ 60°. 89 patients with a median age of 59years and a median curvature of 70 (20-90)° were identified. Dorsal curvature was predominant in 66% of cases, followed by lateral (16%), ventral (8%), and complex curvatures (10%). Partial plaque excision was performed in 98% of patients, with an average grafting area of 2.1cm2; 71% had a singular penile plaque, while 29% presented two or more plaques. The comparison between patients with curvatures ≤ 60° and > 60° revealed no significant differences in mean operation time (86.3 vs. 94.4min, p = 0.13) or in the incidence of postoperative complications, including glans necrosis, hypoesthesia, ecchymosis, bleeding, hematoma, infection, residual curvature, revision surgery, or pain. Early postoperative outcomes and complication rates following plaque incision or partial plaque excision and grafting with CFG were comparable in patients with mild/moderate and severe PD deformities. The technique may be a viable option with a similar risk profile for achieving penile straightening in selected PD cases, particularly when plication is not feasible.

Efficiency of Early Penile Rehabilitation on Erectile Function Recovery after Open Radical Prostatectomy

Prostate cancer (PC) is one of the most commonly diagnosed malignancies worldwide and the second leading cause of mortality among men (1). Nowadays, radical prostatectomy is considered the primary therapeutic modality for treating patients with localized PC (stage pT2), providing a five-year survival rate of nearly 100% (2). Sexual dysfunction in men associated with PC treatment encompasses three distinct entities: erectile dysfunction (ED) and penile shortening; ejaculatory and orgasmic dysfunction; and psychosexual dysfunction, which pertains to sexual desire, intimacy, and mental health (3). Penile rehabilitation (PR) is defined as the use of any intervention or combination of procedures aimed not only at achieving an erection sufficient for satisfactory sexual intercourse but also at restoring erectile function to its preoperative level (4). Despite eff orts to preserve the neurovascular bundle during radical prostatectomy, ED remains a common outcome. Although prevalence rates of ED after the procedure vary widely, recent studies report rates as high as 85% (5). This is primarily due to the lack of control over factors that significantly influence the erection recovery, such as the patient’s age, preoperative erectile function, comorbidities, surgical approach (open, laparoscopic, or robot-assisted), surgical technique (non-, uni-, or bilateral nerve-sparing), and the surgeon’s skills and experience. The pathophysiology of postoperative ED is multifactorial. The primary mechanisms are believed to be damage to the cavernous nerves, whether through dis-section or neuropraxia, and vascular injury, which includes damage to the accessory pudendal arteries, hypoxia and fibrosis of the endothelium and smooth muscle, resulting in penile shortening (6-8). Although there is no consensus on the optimal approach to PR, accepted modalities include the use of phosphodiesterase type 5 inhibitors (PDE-5i; such as sildenafil, vardenafil, tadalafil) and vacuum erection de-vices (VED) or vacuum constriction devices (VCD) as first-line therapies. Second-line treatments involve prostaglandin E1 preparations for intracavernous, or intraurethral (MUSE – “Medicated Urethral System for Erection”) administration. The final therapeutic option is the implantation of penile prostheses (3-10).

Early Inflatable penile prosthesis implantation offers superior outcomes compared to delayed insertion following ischemic priapism: a narrative review.

Ischemic priapism is a urological emergency which may lead to irreversible erectile dysfunction. One of the accepted treatments is penile prosthesis implantation. Given the scarcity of studies directly comparing timing of penile prosthesis insertion after ischemic priapism, consensus remains elusive. We aim to compare different studies in the literature concerning advantages and disadvantages of early versus delayed inflatable penile prosthesis following ischemic priapism. We analyzed 8 articles that investigated immediate and delayed inflatable penile prosthesis placement after ischemic priapism. Early inflatable penile prosthesis placement is associated with better outcomes, including pain relief, priapism resolution, penile shortening prevention, and quicker sexual activity resumption. However, it still carries a high risk of complications like edema, infection, and distal perforations. Delayed inflatable penile prosthesis insertion poses surgical challenges due to the potential for extensive corporal fibrosis. Comparative analyses have shown elevated complication rates in patients with ischemic priapism who undergo delayed inflatable penile prosthesis insertion, as opposed to those with early insertion. In studies reporting complications rates, the total complication rate in the early group was 3.37%, significantly lower than the delayed group (37.23%). Most studies support the superiority of early inflatable penile prosthesis placement following ischemic priapism over delayed placement. Further research is, however, needed to establish a global consensus on timing of prosthesis insertion.

A contemporary systematic review of penile lengthening procedures with penile prosthesis.

Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile lengthening procedures (PLPs) can be performed concurrently with penile prosthesis (PP) insertion in patients with severe ED, penile shortening, and/or Peyronie's disease to help combat negative emotional and psychological concerns from penile length loss with penile prosthetic device placement. An extensive, systematic literature review of the various pre-, intra-, and post-operative techniques that can be applied to preserve, restore or enhance penile length at the time of penile prosthetic implantation. Numerous pre-operative and post-operative inflation protocols exists with vacuum erection devices and penile traction therapy. Intraoperative surgical techniques include cavernosal sparing and channeling without dilatation, subcoronal incision with circumferential penile degloving and grafting, the sliding technique, the modified sliding technique, the multiple-slit technique, the tunical expansion procedure (TEP), modified TEP, and the auxetic expansion procedure. These approaches can be meaningful to restore and/or preserve length for patients undergoing PP insertion. PLPs can be performed by surgeons who have extensive penile reconstruction experience and have been trained to do these procedures, as there is significant risk to the patient and limitations to what can be expected. Each patient must be counseled in detail about the risks and benefits of these procedures and have their expectations managed as the average postoperative penile length recovery is around 3 cm and can range from 0-4.0 cm. Future research is needed to identify the appropriate candidate for each approach, and how much length gain the patient can expect.

Сексуальная дисфункция и репродуктивные нарушения как осложнения реконструктивных вмешательств на уретре.

Introduction. Reconstructive interventions on the male urethra present a complex surgical challenge. It is crucial not only to restore the anatomical patency of the urethra but also patients’ quality of life. The onset of sexual dysfunction after the operation significantly reduces the patients' quality of life and their perception of treatment outcomes. Objective. To conduct a review of the current literature on sexual and reproductive disorders following reconstructive interventions on the male urethra. Material and methods. Literature search was conducted using the PubMed, Google Scholar, and eLibrary databases up to August 2023. The search was performed using keywords in both Russian and English, including urethroplasty, urethral stricture, sexual dysfunction, ejaculatory dysfunction, penile shortening, penile curvature, and cold glans. Results. The development of sexual dysfunction after reconstructive interventions on the urethra depends on anatomical factors, surgical technique, and the extent of urethral involvement. Erectile dysfunction is present within the first 6 months after the surgery, followed by gradual recovery. The development of ejaculatory dysfunction, penile shortening or curvature, as well as impaired sensitivity, depends on the chosen surgical approach. Conclusion. The literature on sexual dysfunction is characterized by heterogeneous studies, making their analysis challenging. Data on reproductive disorders following urethroplasty are presented only in a few studies. To further assess surgical und functional outcomes it is necessary to conduct multicenter studies using validated questionnaires.

(098) Does Early Implantation of Penile Prosthesis for Ischemic Priapism Associated with Decreased Complication Rate? A Systematic Review of Literature

Abstract Introduction Ischemic priapism (IP) is a prolonged undesired erection that accounts for &amp;gt;95% of all priapism episodes. Like compartment syndrome, it is characterized by diminished corporal blood flow and can lead to corporal fibrosis, penile shortening, and refractory erectile dysfunction. Penile prosthesis (PP) implantation is the treatment option in IP to treat the priapic episode and to preserve erectile function. However, no standardization exists regarding the optimal timing of PP implantation surgery. Objective The present review aims to systematically analyse the literature comparing early and delayed PP implantation in patients with IP. Methods A systematic search on PubMed, Scopus, and EMBASE databases were searched from inception to July 1st, 2023 and followed by hand searching. All the steps were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We assess the quality of evidence and the risk of bias in each included study. Results Three retrospective cohort studies comprising 199 subjects were included in this systematic review. All studies have different definitions of the timing of early PP implantation, ranging from within one week to ≤6 months from the onset of priapism. Despite different types of PP used, all studies agreed that early PP implantation results in lower intraoperative complications, such as corporeal perforation and urethral injury, greater preservation of penile length and girth, and a lower rate of prosthetic revision. On the other hand, the delayed insertion was linked to a longer surgical time because of challenges brought on by fibrotic tissue, with most of them also requiring a smaller cylinder. In regards to post-operative complication, the majority of studies demonstrated that delayed implantation would result in a higher rate of complication rate; however, one study demonstrated that early PP implantation had a higher likelihood of prosthesis erosion and infection, which was believed due to a higher rate of bacterial invasion during the earlier shunt surgeries. Conclusions The majority of current evidence favours early penile prosthesis insertion in term of lower complication rate for IP, especially the intraoperative complication, for IP, compared to the delayed implantation. Nevertheless, better quality evidence is still needed from RCT to determine the exact timing for early implantation, patient selection, and the best penile prosthesis types. Disclosure No.

(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.

(166) Surgical Excision and Grafting with Simultaneous Dorsal Plication for Ventral Plaque Accompanied by Urethral Tethering

Abstract Introduction Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision, or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. Objective We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. Methods The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Results Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures. Conclusions The correction of severe ventral curvature deformity can be challenging, the surgeon should be prepared to perform additional correction procedures if penile straightening was limited by the tethering of the neurovascular bundle or urethra. Excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results. Disclosure No.

Plication surgery does not produce additional loss of length in Peyronie's disease patients.

Nesbit's procedure remains a cornerstone in surgical management of Peyronie's disease, despite the subjective loss of penile length. This retrospective study demonstrates that the perceived length loss has already occurred prior to surgery and that the Nesbit's procedure does not produce additional loss of length. Ninety-one patients who had undergone Nesbit's procedure between 2017 and 2022 at the Department of Urology of the University of Trieste were enrolled in the study. Preoperative stretched penile length and postoperative stretched penile length were measured. The curvature was uniplanar in 78 patients and biplanar in the remainder. Mean degree of the main curvature was 52.58° ± 14.13° and mean number of plications was 2.42 ± 1.07. Analysis revealed that the median of the differences between preoperative stretched penile length and postoperative stretched penile length was not significant (p = 0.466). According to our results, no significant penile shortening occurs as immediate consequence of Nesbit's procedure, as length is defined by the shorter side of the shaft affected by Peyronie's disease. Hence the length loss should have to be attributed to Peyronie's disease itself and could have been accurately predicted preoperatively allowing for a more accurate counseling of patients. Further studies are pending to assess potential postoperative loss of length due to scarring contracture.

(315) Evidence Analysis for Contemporary Vascular Therapies for Erectile Dysfunction

Abstract Introduction Erectile Dysfunction (ED) is a common male sexual disorder that is caused by various conditions including vascular dysfunction. Different treatment options can be implemented, like lifestyle modifications, pharmacological intervention, or surgical procedures. In select ED cases, vascular procedures such as penile revascularization and venous ligation could be an alternative option. Objective We herein evaluated the current evidence and outcomes of penile revascularization, venous ligation and other vascular surgery with specific emphasis on complications and patients’ satisfaction. Methods A literature search was conducted using PubMed and Google Scholar to examine papers from 1993 to present day. Keywords, such as, “Erectile dysfunction”, “ED vascular surgery”, “Penile venous ligation”, “Penile revascularization”, and “Arterial bypass surgery”, were used in this search. All the papers were in the English language. Results A total of four studies met inclusion criteria for penile arterial bypass and dorsal penile venous ligation procedures with erectile function, clinical outcomes, satisfaction rates and post operative complications. Regarding penile arterial bypass, two studies identified. First study reported inferior epigastric artery (IEA) to the penile dorsal artery of 1500 patients reported success rates of erectile function were 67% and satisfaction rates of 89%. Postoperative complications were anastomotic disruption, penile skin sensation loss and pain. Regarding venous ligation of penile dorsal vein, two studies identified. First study of 100 patients reported success rates of erectile function were 62% at 1 year. Second study of 26 patients reported success rates of erectile function were 42.3% and satisfaction rates of 57.7% at 3.7 years. Postoperative complications were painful erections, skin necrosis, and penile shortening (Table 1). Conclusions Vascular therapies including penile arterial bypass and penile dorsal venous ligation for ED could provide improved clinical outcomes and satisfactions in select patients’ population. Future studies are warranted to further evaluate its surgical outcomes and long-term safety and efficiency. Disclosure No.

(223) Using Aglan Flap in Peyronie`s Surgery

Abstract Introduction Surgical therapy is indicated if: 1- Deviation compromises or makes sex practice impossible. 2- Conservative treatment has failed. 3- Disease duration is at least 12 months. 4- The stable phase is at least 6 months. When deviation is greater than 60 degrees many centers prefer a grafting procedure to avoid penile shortening, grafting procedures leads to potential lengthening of the concave side of the deviation. The resulting tunical defect may be filled using an auto graft .e.g. detubulerized saphenous vein, fascia-lata, buccal mucosa, allograft e.g human pericardial tissues and human fibrinogen and thrombin coated onto equine collagen sponge, or xenografts e.g bovine pericardial and bovine intestinal submucosal tissues. Currently there is no consensus on the most suitable graft material for penile graft, many surgeons used synthetic grafts e.g self-adhesive collagen fleece, we were used the elastic wall of silicone caps with penile implants as a cover to the defects during implantation with peyronie`s previously. Synthetic grafts has the risk of infection, sensory loss, altered glans sensation, recurrent curvature due to graft contraction and length loss. So synthetic grafts should be avoided. Penile plication is simple and minimally invasive but invariably may results in penile length loss and may in fact worsen the existing hour-glass or hinge effect. Objective Presentation of new method to cover defects in peyronie`s diseases. Methods Methods two patients were operated, excision of the plaque was done, dissection of caval tissues in subtunical plane, elevation of Aglan caval flap, penile implantation (maliable), covering of the implant by the flap and suturing, second layer of the nearby tissues was added. The dissection could be done up to 360 degrees. Results Follow up for six months was done, both patients have no complications initial decrease in sensation was reported, improved within 3 months completely, the flap is safe, very vascular could be based at any point. It is natural, economic with minimal side effects if compared with synthetic grafts. Obvious nerves at area of excision should be retracted away if possible for maintenance of sensation. It could be used to cover defects with peyronie`s or other tunical defects with implantation. Conclusions Aglan flap is safe, economic, simple and effective method for covering tunical defects in peyronie`s disease. Disclosure No.

(191) Excision and Grafting with Concomitant Dorsal Plication for Ventral Plaque with Urethral Tethering

Abstract Introduction Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. Objective We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. Methods The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Results Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures. Conclusions The correction of severe ventral curvature deformity can be challenging, the surgeon should be prepared to perform additional correction procedures if penile straightening was limited by the tethering of the neurovascular bundle or urethra. Excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results. Disclosure No.

(205) Functional Outcomes in Non-Transecting Excision-Anastomosis Urethroplasty for Lengthy (≥2cm) Urethral Strictures

Abstract Introduction Spongiosal sparing non-transecting anastomotic bulbar urethroplasty has rapidly become the preferred technique for many reconstructive urologists due to reported improvement in postoperative erectile function outcomes. For strictures &amp;lt;2cm, non-transecting techniques without the use of graft augmentation are typically deployed. However, for lengthy bulbar strictures (≥2cm), many advocate for oral mucosa substitution urethroplasty due to the theoretical concern of penile shortening, tethering, or other erectile function related side effects. Although effective, substitution bulbar urethroplasty is associated with additional graft harvest morbidity and may have lower success rates relative to non-substitution non-transecting techniques. Objective We describe outcomes of an extended non-transecting excision-anastomosis urethroplasty for lengthy urethral strictures without the use of graft augmentation. Methods A tertiary center’s urethroplasty database was queried for patients that underwent non-transecting bulbar urethroplasty from 2017-2023. Patients with penile urethral strictures or concurrent urethroplasty procedures were excluded. Stretch penile length (SPL) was assessed by applying gentle traction on the penis and measuring from the base of the penis to the tip of the glans. SPL was assessed perioperatively and at 3-6 month follow-up. Urethral stricture recurrence was defined as need for repeat urethral intervention. Urethral stricture length was determined by intra-operative measurement. Accordingly, patients were then stratified based on stricture length (&amp;lt;2 cm vs ≥2 cm) and tested for association between categorical outcomes (worsening erectile function and reconstructive success) and continuous outcomes (change in SPL) using Fischer’s exact test and Mann Whitney U test. Results A final cohort of 90 patients were identified, with a median urethral stricture length of 1.5 cm (range 0.5-6cm). In addition to dorsal urethrotomy (median 3cm), ventral mucosectomy was performed in 29 (32%) patients (median 2cm). Early postoperative complications occurred in 13 (15%) including UTI (N=4), contrast extravasation at VCUG (N=3), and epididymo-orchitis (N=3). At a median follow up of 13 months (IQR 4-18), a total of 5.5% (5/90) developed stricture recurrence. The overall median change in SPL was 0% (IQR 0-6.7%). De novo ED occurred in 7% (5/67). When stratified by stricture length ≥2cm (N=41) and &amp;lt;2cm (N=49) median length of urethrotomy was 3 cm (2.6-4.0) vs 2 cm (2.0-3.0; p &amp;lt;0.001), respectively. Those with strictures ≥2 cm had greater decreases in relative SPL (median 3.5% vs. 0%, p = 0.003) and higher absolute PVR (median 71 ml vs. 34 ml, p =0.03) at 3 months after surgery. There were no significant differences in relative improvement of Qmax or PVR, stricture recurrence (8% vs 4%), worsening erectile function (10% vs 6%), or complication rates (15% vs 14%) between groups (p-value&amp;gt; 0.05 for all comparisons). Conclusions Spongiosal sparing non-transecting urethroplasty is an effective surgical option for patients with lengthy urethral strictures. It offers comparable relative improvement in functional (Qmax, PVR) and erectile function outcomes, while having a modest impact on SPL all while avoiding the morbidity of graft harvesting. Disclosure No.

(187) The SAPOC Technique: Slices Around Point of Maximal Curvature at Time of IPP placement in Severe Peyronie's Disease

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease and erectile dysfunction (ED). Most cases involving plaque incision and graft placement are performed at the point of maximal curvature which result in a large defect that requires placement of a large graft while postoperative penile shortening remains a significant concern among patients. Objective To present a video of a novel modification of the multiple slit technique (MUST) for the treatment of severe PD and ED during IPP placement. This technique involves multiple relaxing incisions made around the point of maximal curvature (POMC) which minimizes the size or even the need of a graft while allowing for length restoration. Methods This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the POMC is identified, 2 to 4 transverse relaxing incisions (slices) are made around the POMC approximately 1 to 1.5cm apart in order to minimize the size of the defect and hence the need or size of the graft. Each slice allows for maximal restoration of length. Results The SAPOC technique results in correction of curvature and length restoration. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex PD and ED. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Boston Scientific and Coloplast.

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.

Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group.

Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life, especially when accompanied by Erectile dysfunction (ED). Various surgical techniques have been described to manage concomitant ED and penile shortening through penile prosthesis (PP) implantation. To evaluate the benefits and risks of different penile length preservation techniques during PP implantation. A systematic review of the available literature on the use of penile length preservation maneuvers in conjunction with PP implantation was conducted. For this systematic review, three databases (Medline, Embase and Cochrane) and clinical trial.gov were queried for relevant publications from 1 January 1990 to 1 September 2022. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The qualitative analysis included 15 relevant articles involving 1186 adult patients who underwent penile length preservation techniques during PP implantation. Penile lengthening of 1-7 cm was reported. Overall, postoperative complications were described in up to 21.7% of cases. Only five studies reported functional outcomes, showing a significant improvement in postoperative period based on the administered questionnaire (e.g. IIEF - International Index of Erectile Function, EDITS - Erectile Dysfunction Inventory of Treatment Satisfaction). Penile length preservation procedures appear to offer a viable option for managing acquired penile shortening, particularly in cases of PD. However, they are associated with a significant risk of complications. Proper patient selection, thorough discussion of risks and benefits, and referral to high-volume centers are mandatory to achieve optimal outcomes and minimizing complications. PROSPERO database registration CRD42022360758.

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.

Prevalence and predicting factors for commonly neglected sexual side effects to brachytherapy for prostate cancer: a cross-sectional observational study

Abstract Background Low-dose-rate brachytherapy (LDR-B) is an established treatment for localized prostate cancer. However, while erectile function is relatively well documented, other changes in sexual function are sparsely investigated. Aim The study sought to investigate orgasmic dysfunction, urinary incontinence during sexual activity (UIS), changes in penile morphology, and sensory disturbances in the penis following LDR-B. Methods A cross-sectional questionnaire-based study in patients who underwent LDR-B at our center from 2010 to 2020. The questionnaire included the International Index of Erectile Function–Erectile Function Domain (IIEF-EF) and questions on orgasm, UIS, changes in penile morphology, and penile sensory disturbances. Outcomes Outcomes were prevalence rates of altered perception of orgasm, orgasm associated pain, anejaculation, UIS, alterations in penile morphology, penile sensory disturbances, and predictors of these side effects. Results Overall, 178 patients responded to the questionnaire. The median age was 70 years (range, 51-83 years), and the median time since LDR-B was 93 months (range, 21-141 months). Overall, 142 (80%) were sexually active and 126 (70.8%) had erectile dysfunction (ED). Of the sexually active patients, 8 (5.6%) reported anejaculation and 7 (4.9%) reported anorgasmia. Another 67 (46.9%) had decreased orgasmic intensity, while 69 (49.3%) reported an increased time to orgasm. Twenty-six (18.3%) patients had experienced orgasm-associated pain with a median visual analog pain score of 2. Considering overlap, 44 (31.0%) patients had an unchanged orgasmic function. Six (3.3%) patients had experienced UIS at least a few times. Penile length loss was reported by 45 (25.2%) patients. Seventeen (9.6%) patients reported an altered curvature of their penis and 9 (5%) had experience painful erection. Thirty-three (18.5%) patients had experienced decreased penile sensitivity. On multivariate analyses, ED was the only independent risk factor for altered perception of orgasm (odds ratio [OR], 6.6; P &amp;lt; .0001), orgasmic pain (OR, 5.5; P = .008), and penile shortening (OR, 4.2; P &amp;lt; .0056). No independent risk factors were identified for UIS or sensory penile disturbances. Clinical implications Patients undergoing LDR-B should be adequately informed about possible side effects, and clinicians should inquire about these during follow-up visits. Strength and Limitations We are the first to comprehensively explore the previously neglected side effects of LDR-B for prostate cancer. Limitations are the cross-sectional design assessing the cohort at different time points following their treatment and the response rate. Conclusions Orgasmic dysfunction, changes in penile morphology, and sensory disturbances in the penis are common side effects of LDR-B for prostate cancer. UIS is only experienced by a small minority.

Patients' attitude with surgery for Peyronie's disease: results from a multicentric European study.

Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes. To explore the rate and factors influencing patients' willingness to undergo surgery for PD. Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery. Patients' willingness to undergo surgery for PD. This study included 343 patients with a median age of 57.3years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P < .0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment. The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures. Main limitations are the cross-sectional design and the potential neglect of confounding factors. Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures.

Multi-Incision Technique (MIT) and malleable prosthesis implantation in patients with Peyronie’s Disease and severe penile shortening, with or without preoperative erectile dysfunction: A multicenter retrospective study

Multi-Incision Technique (MIT) and malleable prosthesis implantation in patients with Peyronie’s Disease and severe penile shortening, with or without preoperative erectile dysfunction: A multicenter retrospective study