Plication Procedure Research Articles

Effects of endoscopic gastric plication on portal pressure gradient in a patient with nonalcoholic steatohepatitis cirrhosis.

Video 1Endoscopic gastric plication (EGP) to treat obesity and nonalcoholic steatohepatitis (NASH) in a patient with compensated cirrhosis, as well as the application of EUS-guided portal pressure gradient (EUS-PPG) measurement to monitor changes in PPG after EGP.

Comparative Study between Medial Rectus Muscle Resection versus Plication When Coupled with Lateral Rectus Muscle Recession in Treatment of Exotropia

Abstract Background: There are many reasons to perform a stra-bismus surgery, either to provide binocular single vision, improve cosmosis, restore normal eye contact and/or enhance the quality of life. Aim of Study: The purpose of this study is to compare between medial rectus muscle plication versus resection when coupled with lateral rectus recession as regard efficacy and possible complications in treatment of exotropia. Patients and Methods: This study was carried out in Ophthalmology Department at Aswan University Hospital between 2019 and 2020 on 40 patients with exotropia. The first 20 pateints were operated by the plication procedure, while, the other 20 patients were operated by the resection procedure. This study was a randomized controlled study. Results: Plication technique was comparable to resection technique as there were no significant differences as regard post-operative results, but plication technique could be safer in prevention of lost muscle and anterior segment ischemia. Also, plication technique was of shorter operation time. Conclusion: MR muscle plication is an alternative easier, safer and faster technique to resection when coupled with lateral rectus recession in treatment of exotropia.

Feasibility of a single endoscopic plication procedure for the treatment of gastroesophageal reflux disease and obesity.

Feasibility of a single endoscopic plication procedure for the treatment of gastroesophageal reflux disease and obesity.

The feasibility and safety of same-day surgery for diaphragmatic eventration by minithoracotomy in children.

The diaphragmatic plication procedure by thoracoscopy has gradually become standard treatment for diaphragmatic eventration (DE). However, thoracoscopic diaphragmatic plication is difficult to manipulate and the surgical learning curve is long. This study aimed to demonstrate the feasibility and safety of same-day surgery for DE by minithoracotomy in children. From December 2017 to December 2019, we included 22 patients who underwent diaphragmatic plication of DE in the Department of Pediatric Thoracic Surgery at the Guangzhou Women and Children's Medical Center. A total of 10 patients underwent diaphragmatic plication by minithoracotomy and 12 patients underwent thoracoscopic plication. The perioperative condition and postoperative follow-up were evaluated, respectively. The age, sex, and weight were no different in the minithoracotomy group versus the thoracoscopy group (P > 0.05). The intraoperative time, blood loss volume, and postoperative hospital stay of the minithoracotomy group were significantly less than that of the thoracoscopy group (31.10 ± 4.70min vs. 72.08 ± 22.8min; 1.20 ± 0.42ml vs. 2.58 ± 1.67ml; and 1.00 ± 0.00days vs. 6.00 ± 2.95days, respectively, all P < 0.05). The eventration levels in these two groups were significantly different in the perioperative and postoperative periods as detected by chest X-ray. No chest tubes were inserted and no recurrence of DE occurred in the thoracoscopy group through the postoperative follow-up of at least 6months. Same-day surgery by minithoracotomy as a treatment for DE was feasible and safe with less operative time, less blood loss, and low recurrence. Same-day surgery for DE was attributed to a quick recovery. More prospective studies are necessary to further explore the consequences of same-day surgery for DE by minithoracotomy.

Treatments of Peyronie's disease with Scutellaria baicalensis and surgery according to the disease course: a single-center retrospective study of 261 patients.

Oral medication therapies are more conventional than other non-surgical therapies in the acute phase of Peyronie's disease (PD). Although the commonly used oral drugs for PD have shown poor or indeterminate outcomes, most patients prefer oral medications. The aim of this study was to evaluate the efficacy and safety of Scutellaria baicalensis extract for treating acute-phase PD patients and examine the practicality of treatment strategies for PD according to the disease course. This retrospective study was performed at our institution from 2005 to 2015 and analyzed the data of 261 patients with PD. The acute-phase PD patients received Scutellaria baicalensis extract for 6 months. After oral treatment, the patients with persistent curvature underwent surgical correction during the stable phase. During this study period, 183 patients received oral treatment with Scutellaria baicalensis, and 78 patients did not. Compared to the untreated patients, treatment with Scutellaria baicalensis had a significant effect in improving the symptoms of acute-phase PD. The mean time required for stabilization also showed a significant statistical difference. Treatment with Scutellaria baicalensis was safe and well-tolerated. After the disease stabilized, 70 and 31 patients with significant penile curvature underwent surgical correction by 16- dot plication and great saphenous vein grafting procedures, respectively. At the one-year follow-up, complete penile straightening and penile length shortening were observed in 92.86% and 41.43% of the patients after 16-dot plication and in 87.10% and 25.81% of the patients after grafting procedures, respectively. The postoperative Erectile Function domain of the International Index of Erectile Function scales were maintained in all patients after the 16-dot plication procedure and decreased in 54.84% of the patients after the grafting procedure. Overall, 92.86% and 83.87% of the patients who received 16-dot plication and grafting procedures, respectively, were satisfied with the final surgical results. Treatment with extract of Scutellaria baicalensis seems to be beneficial for improvements in symptoms of acute phase PD and acceleration of the disease stabilization. The 16-dot plication and great saphenous vein grafting procedure seem effective options in the surgical management of the stable phase after Scutellaria baicalensis administration in the acute phase of PD.

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p=.753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.

Konjenital Penil Kurvatürde Absorbable Monofilament Sütür Kullanılarak Yapılan Modifiye Nesbit Plikasyonunun Uzun Dönem Sonuçları

Objective: To analyze the long-term results of the congenital penile curvature (CPC) corrected with modified Nesbit plication procedure using monofilament absorbable sutures. Material and Methods: From March 2008 to March 2018, 54 adult patients with CPC underwent the modified Nesbit plication surgery procedure. Absorbable monofilament poliglecaprone-25 suture was used for plication in all patients. Patients older than 16 years of age in March 2008 were included in the study which have minimum 20 degree penile curvature. Long -term follow-up was median 68 (16-120) months and data were available for 48 patients. Results: All of the patients were curvaturefree at the end of the operation. At the time of the follow-up examination, 40 (83.3%) patients were curvature-free. Five (10.4%) had recurrent curvature less than 15 degree and the other 3 (6.2%) had curvature recurrence >15 degree. Disturbing palpable suture knot was detected in only 3 (6.2%) patients. While 38 (79.2%) patients were very satisfied with the operation, 6 (12.5%) stated to be moderately satisfied and 4 (8.3%) were unsatisfied at all. Conclusion: Absorbable poliglecaprone-25 suture provides high success rate in CPC surgery and significantly reduces suture related complications.

Factors associated with unplanned reinterventions and their relation to early mortality after pediatric cardiac surgery

ObjectiveUnplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. MethodsMorbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uRE patients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. ResultsA total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). ConclusionsuREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Salvage Penile Plication Is an Effective Modality for Resolving Residual Curvature After Surgery for Peyronie's Disease.

IntroductionPenile plication is highly successful in appropriately selected patients with Peyronie’s disease; however, a minority of patients experience residual curvature or delayed recurrence of curvature. Revision surgery outcomes are seldomly reported.AimTo determine the efficacy of salvage penile plication for the correction of residual and recurrent curvature.MethodsOur institutional review board–approved prospective single-surgeon database of patients with Peyronie’s disease was reviewed for cases performed from 2011 to 2019. Patients requiring salvage procedures were analyzed. A successful salvage was defined by residual curvature <20° with patient-reported satisfaction. Potential etiologies for initial plication failure were examined.Main outcome measureThe outcomes of this study are subjective and patient-reported success of salvage plication.ResultsData analysis identified 134 men treated surgically for Peyronie’s disease. Management involved plication in 105 (78.4%), incision and grafting in 14 (10.4%), excision and grafting with inflatable penile prosthesis in 7 (5.2%), plication with inflatable penile prosthesis in 6 (4.5%), or grafting, plication, and inflatable penile prosthesis in 2 (1.5%). Mean preoperative degree of curvature before initial surgery was 55° (30°–90°). Of this cohort, 5.2% (n=7) required salvage plication for a median residual or recurrent curvature of 45° (35°–90°). Initially, 3 men (43%) received an 8-dot plication, 3 (43%) underwent 16-dot plication, and 1 (14%) received plaque incision and grafting. Among salvage patients, 4 (57%) had initially satisfying results followed by recurrence of curvature and 3 (43%) desired correction of residual curvature. Salvage plication entailed an 8-dot plication in 3 (42.9%) and a 16-dot plication procedure in 4 (57.1%). The median time to salvage surgery was 9 (3–15) months, with all patients showing intraoperative resolution of curvature. At a median follow-up of 12 (1–20) months, 6 (85.7%) patients reported satisfaction with residual curvature <20°.ConclusionPatients with residual or delayed recurrence of curvature after plication for Peyronie’s disease can be effectively managed with salvage plication.Deebel NA, Scarberry K, Dutta R, et al. Salvage Penile Plication Is an Effective Modality for Resolving Residual Curvature After Surgery for Peyronie's Disease. Sex Med 2020;8:686–690.

Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication.

This study aims to evaluate the return to sport and correlations of patients with symptomatic borderline hip dysplasia (BHD) after hip arthroscopy and T-shaped capsular plication at a minimum follow-up of 24months. Twenty-five patients who underwent hip arthroscopy and T-shaped capsular plication for symptomatic BHD were included in the study. All the patients were evaluated clinically prior to surgery (T0) and at two consecutive follow-ups (T1:15 ± 1.2months and T2: 53.9 ± 23.2months) using the visual analogue scale (VAS) pain score, whereas sports activity was assessed by the Hip Outcome Score Sport Specific Subscale (HOS-SSS), the University of California, Los Angeles (UCLA) activity scale, the Tegner score and the physical component (PCS) of the Short Form-12 (SF-12). Furthermore, the presence of correlations and the possible differences between subgroups were evaluated and analysed. A significant difference was found for HOS-SSS, VAS, Tegner, UCLA and PCS with the Friedman test for repeated measures through time points (p < 0.0001). Moreover, all the scores reported significant improvement compared to the previous time point (p < 0.0001) except the HOS-SSS between T1 and T2 (n.s.). Body Mass Index (BMI) was negatively correlated with HOS-SSS at T0 (rho = -0.526 p = 0.006) and T1 (rho = -0.425; p = 0.034), with Tegner at each follow-up (T0: rho = -0470 p = 0.017; T1: rho = -0.450; p = 0.024; T2: rho = -0.448; p = 0.024), with UCLA at T1 (rho = -0.396 p = 0.049), with pre-operative PCS (rho = -0.413 p = 0.0401), and positively correlated with pre-operative VAS (rho = 0.436 p = 0.0291). Hip arthroscopy and T-shaped capsular plication in young patients with symptomatic BHD demonstrates a significant increase in return to sport and physical activity and low risk of complications. T-shaped capsular plication procedure may be considered in young and active patients for whom non-operative treatment failed and who have a significant limitation in sports activity; in these patterns of patients, the ideal treatment should reliably allow fast recovery in combination with very low invasiveness which will prevent osteoarthritis. The results of this study provide more accurate information regarding return to sport in patients with BHD after hip arthroscopy and T-shaped capsular plication. Level IV.

Does Repositioning of Temporomandibular Joint Disc With Bone Anchors Provide Better Clinical Outcomes Than Conventional Disc Plication Procedures for Anterior Disc Displacements Without Reduction in Patients Refractory to Nonsurgical Treatments?

Although open temporomandibular joint arthroplasty with discopexy is a common treatment for patients with anterior disc displacements without reduction (ADDWo) unresponsive to medical management, there are no studies comparing disc repositioning with bone anchors and conventional discopexy procedure. The purpose of the study was to compare the efficacy between disc repositioning with bone anchors and the conventional discopexy procedure for ADDWo of temporomandibular joint refractory to medical management. A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening (primary outcome variable) between the 2 treatment (primary predictor variable) groups-disc repositioning with bone anchors versus conventional disc plication. Secondary outcome variables were pain measured by visual analog scale, lateral excursions, and position of the disc evaluated by magnetic resonance imaging (MRI). Other variables of interest were age, gender, and duration of symptoms. The parameters were evaluated at preoperative, postoperative day 1, and 1-, 6-, and 12-month postoperative period. Categorical variables were compared with χ2 test and continuous variables with analysis of variance and adjusted for multiple comparisons with Bonferroni test. The study sample comprised 14 patients (7 in each group) with MRI-proven ADDWo. Statistically significant differences were found in the improvement of mouth opening between the 2 groups, showing better improvement with bone anchors (14.42±5.96 vs 7.57±7.25mm; P<.05). The reduction in visual analog scale also showed statistically significant difference with better pain reduction achieved with bone anchor (4.57±1.61 vs 3.28±0.75; P<.05). There was no statistically significant difference in lateral excursions and postoperative position of the disc evaluated by MRI between the groups at the 12-month follow-up period. Disc repositioning with bone anchors provides better clinical outcomes in terms of maximal mouth opening and pain scores compared with conventional disc plication.

981 RESECTION AND PLICATION (RAP): AN ENDOSCOPIC ANTI-REFLUX SOLUTION IN ALTERED ANATOMY

In recent years, significant advances have been made in the treatment of gastroesophageal reflux disease (GERD). Options for therapy have expanded in the surgical field, and new endoscopic options have emerged as alternative means of treating GERD in select populations. However, GERD remains a common problem in many polulations that do not quality for these new therapies, either due to severe co-morbidities or altered anatomy. The Resection and Plication (RAP) procedure is a novel endoscopic option for the treatment of medication refractory GERD. The RAP procedure can uniquely be empolyed in patietns unable to undergo surgical or alternate endoscopic anti-reflux therapies due to gastroesophageal junction (GEJ) anatomy that has been altered, for example in patients with prior nissen fundoplication, roux-en-Y gastric bypass, sleeve gastrectomy, or esophagectomy. The RAP procedure involves band endoscopic mucosal resection (EMR) semi-circumferential mucosectomy at the GEJ followed by full-thickness plication (RAP). Endoscopic suturing creats a gastro-gastric plication which serves to tighten the GEJ and decrease the rate of reflux into the esophagus. The following video demonstrates the RAP procedure in 2 patients with altered anatomy. Case 1, 66-year-old female with GERD previously treated with Nissen Fundoplication 10 years ago presents with refractory GERD symptoms. Case 2, 44-year-old female with history of morbid obesity treated with roux-en-Y gastric bypass with initial weight loss, now with significant weight gain and morbid obesity who is presenting with persistent GERD symptoms. 26 patients have undergone the RAP procedure at our institution. The average procedure time is 31 minutes. Ninety percent of were discharged the same day without major complications. Eighteen patients had altered anatomy (5 Fundoplication, 4 Gastric Bypass, 4 Esophagectomy, 2 failed TIF, 2 Endoscopic Sleeve Gastroplasty, 1 Sleeve Gastrectomy). We observed dramatic improvements in Reflux Disease Questionnaire (RDQ) and GERD Health Related Quality of Life (HRQL) questionnaires (RDQ Frequency 80%, RDQ Severity 76%, GERD-HRQL 85%). Sixty percent of patients were able to stop or decrease PPI use at follow-up. The average follow-up period was 6 months. The Resection and Plication (RAP) procedure is a novel endoscopic endoscopic anti-reflux procedure which results in gastro-gastric plications just below the level of the GEJ, thereby reducing the rate of reflux of gastric contents into the esophagus. This provides an effective endoscopic option in patients who otherwise cannot get other surgical or endoscopic therapies, specifically due to prior surgeries. This is a same day procedure and is overall safe, well tolerated and patients report a high degree of satisfaction following therapy.

Sa1937 ENDOSCOPIC GASTRIC PLICATION FOR THE TREATMENT OF WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS

Gastric Plication (GP) involves inverting the stomach with tissue anchor placement to achieve serosa to serosa apposition and permanent gastric remodeling that is challenging to achieve with endoscopic suturing. One potential application of GP is the treatment of weight regain following Roux-en-Y gastric bypass (RYGB) by placing plications around the gastrojejunal anastomosis (GJA) and in the pouch to reduce their sizes. To assess technical feasibility, safety and efficacy of GP at treating weight regain following RYGB. This was a prospective registry study of RYGB patients who underwent GP for weight regain. The GJA was ablated with argon plasma coagulation (APC) (forced, 0.8 L/min, 70-80 watts). Plications were then placed in the ablated area and in the pouch (Figure 1). Technical success, clinical success defined as achievement of at least 5% total weight loss (TWL) at 1 year, and adverse events (AEs) classified using the ASGE lexicon were reported. Additionally, the amount of weight loss, reported using %TWL, at 1 and 2 years was determined. 44 RYGB patients (41F, age 50±11) underwent GP for weight regain and were included. Average BMI and weight regain were 38.8±7.9 kg/m2 and 41.7±28.6% of the maximal weight loss. Pre-GP GJA and pouch sizes were 17±7 mm and 5±2 cm, respectively. Technical success rate was 100%. Average procedure time was 66±20 minutes. APC around the GJA was performed in all patients (100%) prior to plication placement (40.9% with 80 watts, 59.1% with 70 watts). The total number of plications per case was 6±3, with 3±2 and 3±2 being placed in the GJA and pouch, respectively. Clinical success rate was 79.3%. At 1 and 2 years, patients experienced 10.3±7.4% and 8.4±12.6% TWL, respectively (p=0.01 for both). Overall AE rate was 15.9%. These included GJA stenosis (13.6%) and epigastric pain due to GJA ulceration at the APC site (2.3%). All stenoses occurred with 80 watt APC and were successfully treated with endoscopic balloon dilation without or with lumen-apposing metal stent. The severe AE rate was 0%. This novel gastric plication procedure appears feasible and safe, with a high response rate and durable weight loss at two years, for the treatment of weight regain following RYGB.

Testicular tunica vaginalis grafting for the treatment of Peyronie’s disease: a case report

Introduction: Peyronie’s disease (PD) is a progressive fibrotic tissue disorder of the penile tunica albuginea. PD can cause the formation of fibrous plaques, penile deformity, pain during erection, penile curvature, and erectile dysfunction (ED). Surgical treatment is the gold standard in PD because it is a fast and reliable therapy. There are many surgical options for PD such as plication procedures, incision and grafting procedures, and implantation of penile prosthesis. There are three types of graft material have been reported: autologous graft, xenograft and synthetic graft. Considering the higher rate of infections, inflammatory reactions and allergies, synthetic grafts are rarely used. Autologous graft is currently widely used because of the incidence of inflammatory reactions and low allergic reactions. Tunica vaginalis grafts are rarely used widely. Testicular tunica vaginalis was first reported as an autologous graft in 1980.Case Report: A 53-year-old man comes to the urology clinic at Sidowaras Hospital complaining of pain during erection and erection cannot be straight. This complaint has been felt since a few months ago but the patient ignored it. An assessment of ED with International Index of Erectile Function (IIEF)-5 score obtained a score of 12 (mild-moderate dysfunction). Physical examination found a curvature of the penis around 700 and in palpation there was a hard lump on the dorsal penis. After the diagnosis was made, testicular tunica vaginalis grafting procedure was performed on this patient. At a 6-month re-evaluation after surgery, patient-reported reduced penile pain on erection with improved erectile function score (IIEF)-5 score 21 (mild dysfunction).Conclusion: Testicular tunica vaginalis grafting was chosen because it is feasible and safe for patient with PD. Testicular tunica vaginalis Grafting used due to their easy incorporation into host tissue and few incidences of local inflammatory reaction.

A variation to the rectus plication procedure

A variation to the rectus plication procedure

Can capsular plication compensate the lack of one suture anchor in an arthroscopic three suture anchor Bankart repair? A comparative study

ObjectiveThe aim of this study was to compare the complication rates and clinical results of labral repair with two suture anchors and capsular plication, and labral repair with three suture anchor fixation in artroscopic Bankart surgery. MethodsSixty-nine patients (60 males, 9 females; mean age: 28.2 ± 7.8 years (range: 16–50)) who had undergone arthroscopic repair of a labral Bankart lesion were evaluated. Group A underwent an arthroscopic Bankart repair with three knotless suture anchors, while group B underwent a modified arthroscopic Bankart repair with two knotless suture anchors and an additional capsular plication procedure. The mean follow-up was 52.5 months. Constant Shoulder Score (CSS), Rowe Score (RS), modified UCLA Shoulder Score (mUSS) and range of motion (ROM) were used as outcome measures. ResultsIn both groups, a significant improvement was detected in functional outcomes at postoperative last follow-up compared to the preoperative period. No statistically significant difference was found (p > 0.05) in clinical scores (CSS; Group A: 89.7, Group B: 80.2) (RS; Group A: 88.2, Group B: 80.2) (mUSS; Group A: 26.3, Group B: 25.7) external rotation loss (At neutral; Group A: 4.5°, Group B: 5.2°. At abduction; Group A: 4.3°, Group B: 5.7°) and recurrence rates (Group A: 13.3%, Group B: 20.8%). Although the difference was not statistically significant, the recurrence rate was higher in group B (20.8%), compared to group A (13.3%), despite the shorter average follow-up time of group B (p = 0.417). ConclusionsArthroscopic repair of labral Bankart lesions with both techniques showed good functional outcomes and stability at the latest follow-up. Higher recurrence rate despite the shorter average follow-up of group B suggests that two anchor usage might not be sufficient for Bankart repair in terms of better stability and less recurrence risk. Level of evidenceLevel III, Therapeutic Study.

Comparison of Patient's Satisfaction and Long-term Results of 2 Penile Plication Techniques: Lessons Learned From 387 Patients With Penile Curvature

To compare the patient's satisfaction and long-term results of 2 penile plication procedures in patients with penile curvature. This retrospective study included 387 patients with congenital penile curvature (n = 260) and Peyronie's disease (n = 127) who underwent surgical correction of penile curvature with penile plication procedures. Of the patients, 202 underwent plication of tunica albuginea with the Lue's 16-dot technique, while 185 underwent highly superficial excision of tunica albuginea with the modified Nesbit corporoplasty. Surgical outcomes and patient's satisfaction were compared between the 2 techniques in all patients. The mean duration of surgery was significantly shorter in the 16-dot plication technique (48.1 ± 7.5 minutes), compared with the modified Nesbit corporoplasty (63 ± 16.9 minutes) (P = .001). Complete penile straightening was achieved in 87.6% of the patients who underwent 16-dot plication technique and in 89.7% of the patients who underwent modified Nesbit plication, revealing no difference (P = .514). The rates of penile sensory loss (P = .001) and de-novo erectile dysfunction (P = .016) were significantly higher in the modified Nesbit corporoplasty than in the 16-dot plication technique, but rate of suture related complications was significantly higher in the 16-dot plication technique than in the modified Nesbit corporoplasty (P = .001). The patients with congenital penile curvature had significantly less ratio of postoperative penile length loss and de-novo erectile dysfunction than Peyronie's disease patients. Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the 2 surgical procedures. Therefore, patients with penile curvature should be informed about outcomes of penile plication procedures, and surgical method should be preferred based on patient's preference and surgeon's experience.

Sling Plication for Failed Midurethral Sling Procedures: A Case Series.

The aim of this article is to report the outcomes of sling plications performed on women who presented with persistent stress urinary incontinence after midurethral sling. All women who underwent sling plication for persistent stress urinary incontinence after placement of either retropubic or transobturator midurethral sling were included in this case series. For plication, first, the suburethral incision was opened. After mobilization of the mesh in the midline, the sling was plicated with absorbable sutures. Descriptive data were extracted from the electronic medical record. Postoperative stress urinary incontinence was diagnosed based on patients' response to the relevant question on the urinary distress inventory and compared this outcome with respect to the original sling placement approach. We identified 36 women who underwent sling plication between March 2013 and November 2016: 26 (72.2%) following a retropubic and 10 (27.7%) following a transobturator sling. Median time between midurethral sling and plication procedure was 6.8 weeks (range, 2-148 weeks). Median follow-up after sling plication was 17 weeks (range, 2-104 weeks). Overall, 24 women (66.6%) reported subjective resolution of stress incontinence. Success rate for plication of retropubic slings was 20 (76.9%) of 26 and significantly higher compared with 4 (40%) of 10 for transobturator slings (P = 0.034). There were no mesh erosions or persistent urinary retention after sling plication. Sling shortening by plication is an effective low-risk option for the management of persistent stress urinary incontinence following a midurethral sling. This approach was found to be more successful after retropubic slings.

Dorsal Wrist Plication for Midcarpal Instability.

Midcarpal instability (MCI) is a cause of chronic wrist pain for which treatment remains controversial. This study's purpose was to determine the outcome of a treatment algorithm for MCI that included immobilization and surgical interventions. We prospectively enrolled 23 consecutive patients (12 males, average age 27 years) with 27 symptomatic wrists. All had generalized wrist pain with an average duration of 22 months. All had MCI and a catch-up clunk that reproduced the symptoms. Initial treatment was full immobilization for 6 weeks. When necessary, recurrence after immobilization was treated with an anatomically based surgical procedure to plicate the dorsal capsule and extrinsic ligaments to stabilize the midcarpal joint. Failure of surgical plication was followed by 4-corner intercarpal arthrodesis when necessary. Patients were observed for instability, grip strength, wrist motion, and Patient-Rated Wrist Evaluation. For 22 wrists there was partial relief of symptoms with full-time cast or orthosis immobilization; however, symptoms quickly returned with mobilization. The other wrists had previously been immobilized and patients refused further nonsurgical care. All patients underwent surgical plication of the dorsum of the wrists. Postoperative follow-up (35 months) showed statistically significant improvements in grip strength and Patient-Rated Wrist Evaluation scores. All patients had improved pain at final follow-up. Most improvement was in female patients aged under 25 years, with hypermobility and without major traumatic or work-related injuries. This contrasted with poorer outcomes in men aged over 25years who had moderate or severe trauma that was mostly work-related. Instability recurred in 2 patients who then had a 4-corner arthrodesis. Immobilization was not successful in controlling pain and recurrence of instability in patients with MCI. Surgical midcarpal capsular plication was less effective in men with posttraumatic instability. The capsular plication procedure was successful in young female patients with ligament laxity and a history of only minor or repetitive trauma and no history of major trauma. Therapeutic IV.