Plication Procedure Research Articles

Integrating SMAS plication and deep plane techniques in facial rejuvenation: A novel approach

IntroductionIn the realm of facial rejuvenation surgeries, deep plane facelift and SMAS plication techniques have been applied with notable efficacy over an extended period, yielding aesthetically pleasing outcomes.Both methods have their own advantages and disadvantages depending on individual circumstances.We endeavored to formulate an effective facelift method by integrating both approaches, aiming to harness the advantageous aspects of each method while addressing their respective drawbacks in a comprehensive manner. MethodsFollowing the preparation of the subcutaneous plane overlying the fixed SMAS, the mobile SMAS was elevated from the deep plane, and a SMAS flap was fashioned.The SMAS flap in the prezygomatic and premasseteric areas was inwardly folded, and a plication procedure was applied using loop sutures from its most medial to lateral aspects. Subsequently, it was secured to the preauricular area with U stitches. The results were statistically evaluated preoperatively and postoperatively using WSRS scores. ResultsA total of 40 patients underwent operative procedures effectively performed by the senior author(F.C.). Preoperative WSRS scores were measured at 4.2 ± 0.52. Postoperative WSRS scores at 3 months were significantly lower at 1.25 ± 0.44 (p<0.05). The facelift procedure was effectively applied in all patients without the development of major complications. ConclusionsThis method combines deep plane facelift and surgical SMAS plication, utilizing the advantages of both techniques to directly address nasolabial folds and achieve gratifying outcomes in facial and neck rejuvenation.

Surgical principles behind pubourethral plication procedure (ULP) with wide-bore polyester sutures.

Surgical principles behind pubourethral plication procedure (ULP) with wide-bore polyester sutures.

Efficacy of different endoscopic treatments for gastroesophageal reflux disease: a systematic review and network meta-analysis

BackgroundThere are no direct comparisons across different endoscopic therapies for gastroesophageal reflux disease (GERD). This study aimed to evaluate the relative effects of different endoscopic therapies in GERD. MethodsFive databases were searched until August 2023 for randomized controlled trials (RCTs) that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication [TIF], endoscopic full-thickness plication [EFTP], and EndoCinch plication procedure [EndoCinch, CR BARD, Billerica, Mass., USA]), or proton pump inhibitors (PPIs)/sham procedure for GERD. Bayesian network meta-analysis was performed. ResultsA total of 19 trials comprising 1181 patients were included. EBL (mean difference [MD], −7.75; 95% credible interval [CrI], −13.90 to −1.44), Stretta (MD, −9.86; 95% CrI, −19.05 to −0.58), and TIF (MD, −12.58; 95% CrI, −20.23 to −4.91) all significantly improved patients’ health-related quality of life score with equivalent efficacy compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (risk ratio [RR], 0.66; 95% CrI, 0.40–1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL [RR, 0.34; 95% CrI, 0.22–0.48] and TIF [RR, 0.38; 95% CrI, 0.15–0.88]). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD, 6.53; 95% CrI, 3.65–9.40) to PPIs. In contrast, TIF was inferior to PPIs in decreasing esophageal acid exposure (MD, 2.57; 95% CrI, 0.77–4.36). ConclusionCombining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP, or EndoCinch in GERD treatment.

Should sacrouterine plication be added to lateral suspension surgery? A prospective study.

Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.

Sutured Transanal Mucosectomy and Plication Procedure.

Sutured Transanal Mucosectomy and Plication Procedure.

(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.

Endoscopic transmaxillary approach to the inferior rectus muscle in correcting traumatic diplopia

Abstract: Traumatic diplopia can be caused by an entrapped, ruptured, or lost extraocular muscle, which is clinically challenging. Numerous surgical approaches can be tailored, depending on which muscle is involved. We present a patient suffering from inferior rectus muscle disruption treated with endoscopic transmaxillary approach and muscle plication procedure. This surgical technique is a novel and effective surgical technique in managing traumatic diplopia.

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.

Endoscopic Gastric Plication: A Flexible and Tailored Alternative to Bariatric Surgery.

Endoscopic procedures are expanding and have been evolving in recent years, increasing their volume along with the development of new devices. This is due to the low morbidity and complication rate, the reversibility of the procedures, and the positive impact on patients. Among the endoscopic procedures gaining interest is sleeve gastroplasty. It emerged as a feasible and safe alternative to traditional bariatric surgery. There are no guidelines available on the indications and use of endoscopic gastroplasty. The aim of this study is to present preliminary results of a case series of endoscopic gastric plication procedures performed for different options: as a primary endoscopic sleeve, as revision for sleeve gastrectomy, and as revision for gastric bypass. A retrospective analysis was performed on a prospective database collecting data on all patients with obesity treated with endoscopic gastroplasty with the Overstitch™ (Apollo Endosurgery, Inc., Austin, Texas) device from 2022 to 2023 in the bariatric surgery unit. Twenty-three patients were treated from May 2022 to July 2023 with endoscopic gastric plication. Ten patients (43%) were submitted to primary endoscopic sleeve gastroplasty, three patients to revision of sleeve gastrectomy, one patient to revision of one anastomosis gastric bypass, and eight patients received a revision of Roux-en-Y gastric bypass. The body mass index (BMI) of patients submitted to primary ESG ranged from 33 to 42kg/m2, with a mean BMI of 37kg/m2. The age of the patients ranged from 22 to 70 years, with a mean age of 45. In one case, we registered a Clavien-Dindo 2 complication-an inflammatory perigastric reaction without a collection occurred 15 days after a primary ESG. Endoscopic gastric plication is emerging as a safe, mini-invasive, and effective procedure alternative to sleeve gastrectomy in patients with I or II class obesity or for those unfit for bariatric surgery. The endoscopic suturing device can be used both as a primary procedure or as a revisional option after failure of the primary surgery, thus proving to be a versatile option to provide to bariatric patients.

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique).

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization. This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness. Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group. This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

MP36-04 PREDICTORS OF PENILE PLICATION AFTER INTRALESIONAL COLLAGENASE CLOSTRIDIUM HISTOLYTICUM INJECTION IN MEN WITH PEYRONIE’S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-04 PREDICTORS OF PENILE PLICATION AFTER INTRALESIONAL COLLAGENASE CLOSTRIDIUM HISTOLYTICUM INJECTION IN MEN WITH PEYRONIE’S DISEASE Taher Naeem, Gal Saffati, Neal Mody-Bailey, Whitney Jin, Sagar Patel, Basil Kaaki, Larry I. Lipshultz, and Mohit Khera Taher NaeemTaher Naeem More articles by this author , Gal SaffatiGal Saffati More articles by this author , Neal Mody-BaileyNeal Mody-Bailey More articles by this author , Whitney JinWhitney Jin More articles by this author , Sagar PatelSagar Patel More articles by this author , Basil KaakiBasil Kaaki More articles by this author , Larry I. LipshultzLarry I. Lipshultz More articles by this author , and Mohit KheraMohit Khera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s Disease (PD) is a common acquired disorder defined by an accumulation of fibrous tissue along the tunica albuginea resulting in a curvature of the penis. This deformity can lead to erectile dysfunction, psychological distress, and pain. Clinical management involves intralesional injection of collagenase clostridium histolyticum (CCH). While efficacious, many cases are refractory, requiring a plication procedure. We seek to investigate predictive factors for plication after receiving a CCH injection. METHODS: A retrospective medical record review was performed on patients who have been treated for PD at an academic institution. Two cohorts were created, those who achieved resolution with initial CCH injection (CCH cohort) and those who failed initial CCH injection and required a plication (plication cohort). Univariate logistic regression modeling was performed to determine statistical significance. RESULTS: A total of 282 patients were included in the study, 11% (n=30) required CCH and a plication while 89% (n=252) had resolution of PD with CCH injection. The median (IQR) ages in the plication and CCH cohorts were 56.7 (50.6 – 63.2) and 57.9 (52.7 – 62.9) years old, respectively. The plication cohort’s median (IQR) degree of initial curvature, (65° [45 - 90]), was significantly greater than the CCH cohort, (45° [40 - 60]); p<0.001. Additionally, in the plication and CCH cohorts, median (IQR) testosterone levels were 343 (230 - 629) compared to 352 ng/dl (255 – 489); p=0.07, hypogonadism was 50% (n=15) compared to 20% (n=51); p=0.70, and median (IQR) plaque size was 8 (1.0 – 14.3) compared to 5.3 mm (1.4 – 9.9); p=0.61, respectively. Median (IQR) time to CCH treatment were 3.5 (2 – 5) and 4 (2 – 9) months in the plication and CCH cohorts, respectively; p=0.15. In the plication cohort, time to plication had a median (IQR) of 12 (8 – 20) months. CONCLUSIONS: Our analysis shows presenting degree of curvature significantly influences the probability of requiring a plication following CCH injection. Additionally, other factors such as hypogonadism, lower levels of testosterone, and larger plaque sizes may point towards trends that could predict progression to plication. These findings could be used to determine when plication should be used over CCH as initial treatment for PD. The effect would conclude in shorter waiting times for resolution of PD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e480 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taher Naeem More articles by this author Gal Saffati More articles by this author Neal Mody-Bailey More articles by this author Whitney Jin More articles by this author Sagar Patel More articles by this author Basil Kaaki More articles by this author Larry I. Lipshultz More articles by this author Mohit Khera More articles by this author Expand All Advertisement PDF downloadLoading ...

V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS

You have accessJournal of UrologyCME1 Apr 2023V04-04 ROBOTIC BLADDER NECK PLICATION FOR INCONTINENCE TREATMENT: TECHNICAL IMPROVEMENTS Dario Guido Minoli, Carolina Bebi, Michele Gnech, Erika Adalgisa De Marco, Irene Paraboschi, Giancarlo Albo, Filippo Molinari, Emanuele Montanari, Gianantonio Manzoni, and Alfredo Berrettini Dario Guido MinoliDario Guido Minoli More articles by this author , Carolina BebiCarolina Bebi More articles by this author , Michele GnechMichele Gnech More articles by this author , Erika Adalgisa De MarcoErika Adalgisa De Marco More articles by this author , Irene ParaboschiIrene Paraboschi More articles by this author , Giancarlo AlboGiancarlo Albo More articles by this author , Filippo MolinariFilippo Molinari More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Gianantonio ManzoniGianantonio Manzoni More articles by this author , and Alfredo BerrettiniAlfredo Berrettini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video we describe our experience in bladder neck plication, robotically assisted, to achieve continence in selected patients. METHODS: In the last three years we performed three robotically assisted bladder neck plication procedures: two females with persistent total incontinence following previous surgeries for ectopic ureters and epispadias and one isolated epispadias in an adolescent male. For all a laparoscopic robotically-assisted bladder neck plication was electively selected. The first two procedures were successfully conducted with Da Vinci SI, while in the third case the Da Vinci XI was used. The progressive narrowing of the proximal urethra was always confirmed with combined endoscopic view. RESULTS: All the patients were discharged on 4th post-operative day without complications. A follow-up MCUG confirmed fully preserved spontaneous voiding without post-void residuals and renal US showed persistence of normal upper urinary tracts. CONCLUSIONS: Bladder neck plication has been described successfully as complementary technique in other procedures as robotic radical prostatectomy. Open bladder neck plication, combined with endoscopic control of the urethral lumen, has been used to reach continence in epispadiac females, too. The anatomical access to the bladder neck region is extremely difficult in open surgery especially in adolescent patients. Robotic access allows a perfect combined endoscopic-laparoscopic approach to the bladder neck area and the firefly vision mode is an extremely useful addition for the correct and precise identification of the urethral segment to be plicated. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e339 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dario Guido Minoli More articles by this author Carolina Bebi More articles by this author Michele Gnech More articles by this author Erika Adalgisa De Marco More articles by this author Irene Paraboschi More articles by this author Giancarlo Albo More articles by this author Filippo Molinari More articles by this author Emanuele Montanari More articles by this author Gianantonio Manzoni More articles by this author Alfredo Berrettini More articles by this author Expand All Advertisement PDF downloadLoading ...

A simple endoscopic full-thickness plication procedure for the treatment of gastroesophageal reflux disease.

Endoscopic full-thickness plication (EFTP) of the cardia or fundus has been shown to have efficacy in treating patients with gastroesophageal reflux disease (GERD) [1] [2]. However, EFTP requires proprietary equipment that may not be available in many countries. Herein, we describe a novel method of EFTP using an endoloop and metal clips, which we termed endoclip and loop cardioplication (ECLC).

Multidirectional instability of the shoulder: surgical techniques and clinical outcome.

Multidirectional instability of the shoulder has a complex pathoanatomy. It is characterized by a redundant glenohumeral capsule and increased joint volume. Subtle clinical presentation, unclear trauma history and multifactorial etiology poseses a great challenge for orthopedic surgeons in terms of diagnosis. Generally accepted therapeutic approach is conservative and the majority of patients achieve good results with rehabilitation. In patients who are symptomatic despite appropriate rehabilitation, surgical intervention may be considered. Good results have been obtained with open inferior capsular surgery, which has historically been performed in these patients. In recent years, advanced arthroscopic techniques have taken place in this field, and similar results compared to open surgery have been obtained with the less-invasive arthroscopic capsular plication procedure.

TH4.7 Seventeen years experience of surgical management of Thoracic Outlet Syndrome at a District General Hospital

Abstract Aims To evaluate the outcomes of patients who underwent first rib resection (FRR) for Thoracic Outlet Syndrome (TOS) over a period of 17 years at a single District General Hospital (DGH). Methods Retrospective review of patient notes of individuals treated with FRR from August 2004 to August 2021. Results Sixty patients underwent 65 subclavian approach FRR for indications neurogenic (n=45 (69%)), venous (n=6 (9%)), arterial (n=14 (22%)) TOS. Forty-four female patients underwent FRR (68%) and mean age at time of surgery 34 years (range 27 to 64 years). Five patients (7.6%) had bilateral FRR and seven patients (10.6%) diagnosed with cervical rib. Mean length of time from initial symptoms to diagnosis 24 months (range 2 to 60 months). Forty patients (62%) underwent a failed trial of conservative management with physiotherapy before proceeding to surgical management. Fifty-two patients (80%) reported complete resolution of symptoms at follow up. Complications included wound infections 2(3%), pneumothorax 4(6%), haemothorax 1(1.5%), phrenic nerve complications 3(4.6%) and chronic pain 1(1.5%). One patient with phrenic nerve injury underwent diaphragmatic plication procedure with resultant resolution of symptoms. Mean length of stay 1.6 days. Conclusions This series presents the difficulty of diagnosis and management of TOS with the majority of patients enduring symptoms for a prolonged period of time before referral and definitive management. Phrenic nerve complications are an underreported complication of subclavian approach FRR, it is essential to counsel patients accordingly before proceeding to surgery. FRR for TOS can be performed safely and effectively in a DGH environment.

Effects of plication procedures in special cases of Peyronie's disease

General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function–Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined. To provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Objective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized. Fifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of "treatment success" varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20˚. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes. While both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting. This report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review. Both plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature.

966 Comparison of Lord and Jaboulay Procedure for Hydrocele Repair

Abstract Aim Hydrocele is a common surgical pathology with a variety of operative techniques described, including Lord plication and Jaboulay procedure. Whilst current evidence suggests no difference in the recurrence rate between different techniques, the Lord’s procedure is described as having the lowest complication rate. NICE guidelines state all men aged 20 - 40 should receive a pre-operative ultrasound scan. We aimed to audit the complication rate between the two procedures as well as the rate of pre-operative ultrasound assessment. Method A retrospective review of all elective hydrocele repairs was performed within one health board over a 17-month period. All elective patients over the age of twelve and three-quarters were included, with emergency repairs excluded. Patient records were accessed, and data collected including hydrocele side and size, procedure performed, co-morbidities, medication, pre-operative ultrasound, and incidence of immediate and late complications. Results 83 cases were identified. All men aged 20 - 40 received pre-operative ultrasound assessment. 27 (33%) repairs utilised Lord’s technique, whilst 56 (67%) used Jaboulay’s technique. There was no statistical difference in complication rate for all complications (10% vs. 16% p = 0.48), haematoma (3.4% vs. 12% p = 0.16), infection (1.7% vs. 12% p = 0.08) or reoccurrence (1.7% vs 0% p = 1.0) between Jaboulay’s and Lord’s respectfully. Conclusions Analysis in this series showed the complication rate is higher for Lord’s procedure versus Jaboulay’s, however this was not found to be statistically significant. All patients aged 20-40 within our analysis received pre-operative ultrasound assessment.

SILENT GIANT LEFT ATRIUM

TOPIC: Cardiovascular Disease TYPE: Global Case Reports INTRODUCTION: Enlarged LA is a common finding in severe mitral stenosis(MS) and severe mitral regurgitation(MR). It can enlarge to giant proportions. The unusual finding in a thirty-year-old woman presenting with only mild dyspnea despite a hugely dilated LA prompted us to report this case CASE PRESENTATION: A thirty-year-old woman presented to the outdoor clinic with the complaint of dyspnea on exertion NYHA class I. Aside from mild shortness of breath during the past year, she had been asymptomatic all her life. The admission electrocardiogram showed atrial flutter with the variable block while her chest roentgenogram showed marked cardiac enlargement. The right heart border showed a double contour of atrial shadow (Fig.2). An echocardiogram showed a giant left atrium measuring 14.4 X 16.7 cm that encroached on the other cardiac chambers (Fig.3). Thickened mitral valves along with doming and restricted motion of anterior and posterior mitral leaflets were diagnostic of rheumatic heart disease(RHD) It was surprising to find a relatively asymptomatic patient despite the marked distortion of cardiac anatomy. DISCUSSION: Giant LA occurs due to many reasons but most commonly its result from long-standing rheumatic mitral valve regurgitation or mixed mitral valve disease with predominant regurgitation. Two factors implicated in its development are increased LA pressure and weakening of the LA wall by Rheumatic Pancarditis. When mitral valve disease persists for long, it leads to LA enlargement as a compensatory mechanism to ease the markedly increased LA pressure which could lead to pulmonary Congestion due to backpressure hemodynamic and hence protect from the development of pulmonary hypertension. These compensatory mechanisms help patients survive asymptomatically for a long time. Giant LA can lead to various complications including thromboembolism, pulmonary edema, pulmonary hypertension and it can compress the esophagus and airway causing Dysphagia. CONCLUSIONS: Progressive LA enlargement might be undetected and well-tolerated for a long time, even when it reaches massive proportions. When the LA enlarges to a gigantic size, a chest x-ray is insufficient to delineate the cause of cardiomegaly and even can be misleading. An echocardiographic study is the most useful method for evaluating these patients. Our case was unusual because the giant LA distorted the cardiac structures. This led to striking cardiomegaly on the chest x-ray, and it confused interpreting the cause of the enlarged cardiac silhouette. The echocardiogram was very helpful in demonstrating the severe MS and the giant LA. There is a poor correlation between the size of the left atrium and the severity of the MS. REFERENCE #1: Kawazoe K, Beppu S, Takahara Y, Nakajima N, Tanaka K, Ichinashi K, Fujita T, Manabe H: Surgical treatment of giant left atrium combined with mitral valvular disease. Plication procedure for reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma. J Thorac Cardiovasc Surg 1983, 85: 885-892. REFERENCE #2: Hurst W: Memories of patients with a giant left atrium. Circulation2001, 104: 2630-2631. 10.1161/hc4701.100775 REFERENCE #3: Plaschkes J, Broman JB, Mercin G, Milwidsky H: Giant left atrium in rheumatic heart disease: a report of18 cases treated by mitral valve replacement. Ann Surg 1971, 174: 194-201. 10.1097/00000658-197108000-00004 DISCLOSURES: No relevant relationships by Vikash Jaiswal, source=Web Response no disclosure submitted for Akshyaya Pradhan; No relevant relationships by Prachi Sharma, source=Web Response No relevant relationships by Shweta Vohra, source=Web Response

V07-08 PENILE PLICATION FOR PEYRONIE'S DISEASE: THE 8-DOT TECHNIQUE

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-08 PENILE PLICATION FOR PEYRONIE'S DISEASE: THE 8-DOT TECHNIQUE Mark Ehlers, Brad Figler, and Alysen Demzik Mark EhlersMark Ehlers More articles by this author , Brad FiglerBrad Figler More articles by this author , and Alysen DemzikAlysen Demzik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile plication is a minimally invasive and effective technique for managing mild to severe curvature from Peyronie’s disease. METHODS: Retrospective chart review of all patients undergoing penile plication for Peyronie’s disease by one surgeon at one academic institution from November 2016 – December 2020 was conducted. Those occurring during IPP placement were excluded. Technical aspects of surgery were detailed and intraoperative video footage was made to illustrate the technique including papaverine injection, incision and variations, tissue dissection, iterative 8-dot plication with absorbable suture, and post operative evaluation. Primary outcomes were intra-operative and long-term success. RESULTS: A total of 66 patients were included. Median age was 58 years old (Range 24-73 years old). Average preoperative curvature was 45 degrees (Range 20-90 degrees). Curvature direction included 64% dorsal, 20% dorsolateral, 8% ventral, 5% ventrolateral, 3% lateral. Overall, 55% had complex deformities (biplanar curvature (38%), curvature of >60 degrees (50%), or both (11%)). Hinge effect was present in 14% of patients. Erectile dysfunction was present in 57% of patients. Ventral minimally invasive incisions were most common (64%) followed by circumcising incisions (24%), only 9% of patients had concurrent circumcision. Median number of 8-dot plication sutures used was 3 (Range 1-12). Intraoperative success, defined as completely straight was 97%. The 2 technical failures were directly related to ability to maintain intraoperative erection. Mean follow up was 4.5 months (IQR 1.1–4.2) and 91% of patients reported straight erections at follow up. No patient with hinge effect had a intraoperative failure or recurrence. There were no major complications. Rate of minor complication (superficial dehiscence, hematoma) was 6%. There were no revision plication procedures or patients who proceeded to penile implant surgery. CONCLUSIONS: This iterative approach to penile plication with absorbable suture is an effective, minimally invasive, and reproducible technique for correcting acquired penile curvature. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Ehlers More articles by this author Brad Figler More articles by this author Alysen Demzik More articles by this author Expand All Advertisement Loading ...