Severe Curvature Research Articles

Excision and Patch Grafting of a Lateral Peyronie's Plaque-Utilizing a Longitudinal "Window" Approach.

IntroductionPeyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used.AimsThe aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time.MethodsA patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting.Main Outcome MeasuresThe main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.ResultsThe plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature.ConclusionA lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.

Image-Guided Spinal Navigation for C1-C2 Instrumentation: Part I.

Disorders of the spine are one of the oldest known human maladies, with descriptions found in ancient medical literature. As in many other areas of medicine, treatment of patients with these disorders has undergone rapid progress over the last century. Among treatment modalities, spinal instrumentation has been a significant technical advancement. Increased use of spinal instrumentation has spurred the need for accurate positioning of screws/instrumentation and enhanced stability of the construct. Traditionally, these have been placed using anatomic landmarks and intraoperative fluoroscopy. In patients with advanced degenerative disease or trauma, or in those with severe curvature deformity, anatomy can be of limited help. With intraoperative fluoroscopy, limited visualization can be a significant issue, especially in patients with a large body habitus. Image guidance, by providing live, accurate information for placement of instrumentation, significantly improves upon these issues. Image guidance has been used in neurologic surgery during recent decades. It was employed initially for intracranial applications, including treatment of brain disorders, with significant benefits and is now used routinely as an important adjunct tool in the operating room for intracranial neurologic surgery. Only more recently has image guidance been used in spine surgery.

Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: Correlation with postoperative complications

The Glans-Urethral Meatus-Shaft (GMS) score is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between GMS score and postoperative complications. Between February 2011 and August 2013, patients undergoing primary hypospadias repair were prospectively scored using the GMS classification. GMS scoring included a 1-4 scale for each component: G - glans size/urethral plate quality, M - meatal location, and S - degree of shaft curvature, with more unfavorable characteristics assigned higher scores [Figure]. Demographics, repair type, and complications (urethrocutaneous fistula, meatal stenosis, glans dehiscence, phimosis, recurrent chordee and stricture) were assessed. Total and individual component scores were tested in uni- and multivariate analysis. Two-hundred and sixty-two boys (mean age 12.3 ± 13.7 months) undergoing primary hypospadias repair had a GMS score assigned. Mean GMS score was 7 ± 2.5 (G 2.1 ± 0.9, M 2.4 ± 1, S 2.4 ± 1). Mean clinical follow-up was 17.7 ± 9.3 months. Thirty-seven children (14.1%) had 45 complications. A significant relationship between the total GMS score and presence of any complication (p < 0.001) was observed; for every unit increase in GMS score the odds of any postoperative complication increased 1.44 times (95% CI, 1.24-1.68). Urethrocutaneuous fistula was the most common complication, occurring in 21 of 239 (8.8%) of single-stage repairs. Patients with mild hypospadias (GMS 3-6) had a 2.4% fistula rate vs. 11.1% for moderate (GMS 7-9) and 22.6% for severe (GMS 10-12) hypospadias (p < 0.001). Degree of chordee was an independent predictor of fistula on multivariate analysis; S4 (>60° ventral curvature) patients were 27 times more likely to develop a fistula than S1 (no curvature) boys (95% CI, 3.2-229). The GMS score is based on anatomic features (i.e. glans size/urethral plate quality, location of meatus, and degree of chordee) felt to most likely impact functional and cosmetic outcomes following hypospadias repair. We demonstrated a statistically significant increase in the likelihood of any postoperative complication with every unit increase in total GMS score. The concept that factors aside from meatal location affect hypospadias repair and outcomes is not novel, and degree of ventral curvature and urethral plate quality are often cited as important factors. In our series, boys with greater than 60° of ventral curvature undergoing a single-stage repair were 27 times more likely to develop a fistula than those without chordee on multivariate analysis, making severe curvature an independent predictor of urethrocutaneous fistula formation. That meatal location did not retain significance on multivariate analysis highlights the importance of considering the entire hypospadias complex when determining severity, rather than just evaluating the position of the meatus. Our study has several limitations that warrant consideration. While GMS scores were assigned prospectively, the data was collected retrospectively, subjecting it to flaws inherent with such study design. Furthermore, type of repair is influenced by surgeon preference and subjective assessment of hypospadias characteristics not incorporated in our scoring system (i.e. tissue quality, urethral hypoplasia, penoscrotal transposition). Despite these limitations, our study demonstrates a strong correlation between the GMS classification and surgical complications, furthering supporting its potential as a tool to standardize hypospadias severity and gauge postoperative complications. The Glans-Urethral Meatus-Shaft (GMS) classification provides a means by which hypospadias severity and reporting can be standardized, which may improve inter-study comparison of reconstructive outcomes. There is a strong correlation between complication risk and total GMS score. Degree of chordee (S score) is independently predictive of fistula rate.

Minimally invasive endodontics.

Minimally invasive endodontics (MIE) aims to preserve the maximum of tooth structure during root canal therapy. In the last 15 years there has been rapid progress and development in endodontics, making treatment procedures safer, more accurate, and more efficient. Meanwhile, reproducible results can be achieved even in difficult root canal morphologies with severe or double curvatures. In addition to various material improvements, the implementation of the surgical microscope (SM) in endodontics is an important innovation, making it possible to optimize each step in the treatment protocol in terms of substance preservation.

AIM analysis and the form of the bond-valence equation

The bond-valence model (BVM) posits an inverse relationship between bond valence (essentially bond order) and bond length, typically described by either exponential or power-law equations. To assess the value of these forms for describing a wider range of bond lengths than found in crystals, we first assume that the bond critical point density (ρ b , reported in e − /A 3 ) is at least roughly proportional to bond valence. We then calculate ρ b -distance curves for several diatomic pairs using electronic structure calculations (CCSD/aug-cc-pVQZ) and Atoms-In-Molecules (AIM) analysis. The shapes of these curves cannot be completely described by the standard exponential and power-law forms, but are well described by a three-parameter hybrid of the exponential and power-law forms. The ρ b -distance curves for covalent bonds tend to exhibit exponential behavior, while metallic bonds exhibit power-law behavior, and ionic bonds tend to exhibit a combination of the two. We next use a suite of both experimental and calculated (B3LYP/Def2-TZVP) molecular structures of oxo-molecules, for which we could infer X-O bond valences of ~1 or ~2 v.u., combined with some crystal structure data, to estimate the curvature of the bond valence-length relationship in the high-valence region. Consistent with the results for the ρ b -distance curves, the standard forms of the bond valence-length equation become inadequate to describe high-valence bonds as they become more ionic. However, some of these systems demonstrate even higher curvature changes than our three-parameter hybrid form can manage. Therefore, we introduce a four-parameter hybrid form, and discuss possible reasons for the severe curvature. Although the addition of more parameters to the bond valence-length equation comes at a cost in terms of model simplicity and ease of optimization, they will be necessary to make the BVM useful for molecular systems and transition states.

A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

The objective of this article is to evaluate the role of different variables affecting the results of tubularised incised plate repair for hypospadias. We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameters were age, severity of hypospadias, degree of curvature and torsion, size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age; Group I- 6 months to 2 years, Group II- 2 to5 years, Group III- 5 to10 years, Group IV- 10 to 15 years and Group V- older than 15 years. Results were analyzed with reference to different variables. Age ranged from 6 months to 26 years (mean 8.8 years). Complication rate when comparing group V and youngest patients (groups I & II) was 20% Vs 3.6% (p=0.08), and when comparing older children (G-III and IV) with youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). More severe hypospadias had higher complications (30% in proximal, 5.7% in distal (p = 0.001). The complication rate was 3.6%, 38.8% and 35.7% respectively in cases with mild, moderate and severe curvature (p = 0.001). Complications were higher in patients with poor spongiosum and higher age (p = 0.001) and in patients with narrow urethral plate (p = 0.0001). Follow up period was from about 10 months to 2 years (mean = 20 months). Urethral fistula and stricture were the most commonly reported complications. Important factors in outcome of TIPU repair were the degree of curvature, width of urethral plate development of spongiosum, age of child and severity of hypospadias. The development of urethral plate and spongiosum is directly proportional to the complication rate. Complications increase significantly with the increasing age of the patient.

The Radix Entomolaris and Paramolaris: A Micro–Computed Tomographic Study of 3-rooted Mandibular First Molars

IntroductionThe morphology of the supernumerary third root (radix) in mandibular first molars was examined by micro–computed tomography (μCT) scanning. MethodsNineteen permanent mandibular first molars with radix were scanned in a μCT device to evaluate their morphology with respect to root length, root curvature direction, location of radix, apical foramen, accessory canals and apical deltas, and distance between canal orifices as well as 2- and 3-dimensional parameters of the canals (number, area, roundness, major/minor diameter, volume, surface area, and structure model index). Quantitative data were analyzed by 1-way analysis of variance and the Tukey test (α = 0.05). ResultsThe mean length of the mesial, distal, and radix roots was 20.36 ± 1.73 mm, 20.0 ± 1.83 mm, and 18.09 ± 1.68 mm, respectively. The radix was located distolingually (n = 16), mesiolingually (n = 1), and distobuccally (n = 2). In a proximal view, most radix roots had a severe curvature with buccal orientation and a buccally displaced apical foramen. The spatial configuration of the canal orifices on the pulp chamber floor was mostly in a trapezoidal shape. The radix root canal orifice was usually covered by a dentinal projection. The radix differed significantly from the mesial and distal roots for all evaluated 3-dimensional parameters (P < .05). The radix canal had a more circular shape in the apical third, and the mean size of the minor diameter 1 mm short of the foramen was 0.25 ± 0.10 mm. ConclusionsThe radix root is an important and challenging anatomic variation of mandibular first molars, which usually has a severe curvature with a predominantly distolingual location, and a narrow root canal with difficult access.

Management der Hypospadie

Hypospadias are diagnosed at birth. Counseling of the parents should be performed in detail. Isolated hypospadias has to be differentiated from disorders of sexual development which are mostly associated with cryptorchidism and micropenis. The operation is timed around the first birthday. Preoperative hormonal treatment should be reserved for infants with a small glans penis or for repeat surgery. The most popular method in distal hypospadias repair is preservation of the urethral plate and tubularization with or without midline incision. In proximal cases with severe curvature a two-stage procedure may be preferable. Dripping-stent urinary drainage into a double diaper is the best method in infants. The complication rate after primary distal repair is reported in the literature to be less than 10% and after staged procedures in proximal hypospadias over 25%.

Long-term results of combined tunica albuginea plication and penile prosthesis implantation for severe penile curvature and erectile dysfunction.

Penile prosthesis implantation is the recommended treatment in patients with penile curvature and severe erectile dysfunction (ED) not responding to pharmacotherapy. Most patients with mild-to-moderate curvature can expect cylinder insertion to correct both ED and penile curvature. In patients with severe curvature and in those with persistent curvature after corporeal dilation and prosthesis placement, intraoperative penile “modelling” over the inflated prosthesis has been introduced as an effective treatment. We report for the first time the long-term results of a patient treated with combined penile plication and placement of an inflatable penile prosthesis.

Influence of root canal curvature on the accuracy of an electronic apex locator: An in vitro study.

Objective:This study investigated whether the canal curvature has an influence on the accuracy of Electronic Apex Locator.Materials and Methods:Sixty mandibular posterior teeth were decoronated. A number (No.) 10 file was inserted into the mesiobuccal canal and radiographs were taken to determine the degree of curvature by Schneider's method. Samples were divided into three groups of mild (<20°), moderate (20-36°) and severe curvature (>36°). After enlarging the orifice, the actual canal length was determined by introducing a file until the tip emerged through the major foramen when observed under 20X magnification. The teeth were embedded in an alginate model and the Root ZX was used to determine the electronic length. The data was analyzed by Kruskal-Wallis test followed by Mann-Whitney test.Results:The difference in measurement of Actual and Electronic working length was statistically significant between group 1 and 2 (P < 0.05) as well as between group 1 and group 3 (P < 0.05) with group 1 showing the lowest difference.Conclusion:Considering ± 0.5 mm as tolerance limit for accuracy, the device was 95% accurate for the mild curvature group and 80% accurate for moderate and severe groups.

Traitements médicaux et chirurgicaux des courbures de verge congénitales et acquises : revue de la littérature

The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.

La maladie de Lapeyronie

Lapeyronie's disease is a common condition affecting 3.4 to 9% of the male population. Knowledge of pathophysiology, natural history, and treatment outcomes can guide the care of patients. A literature review was carried out between 1940 and 2012 in Pubmed using the keywords: Lapeyronie's disease, Peyronie's disease (PD), pathophysiology of PD, surgical treatment for PD, medical treatment for PD. Seventy-five articles were selected, including original articles, reviews, and recommendations in English or French. Few studies available are of level 1 and most of them are of 2b and 3 level of evidence. The pathophysiology of Lapeyronie's disease is controversial. Medical treatments are ineffective. Surgery should be proposed when the curvature is stabilized, and the treatment of the concavity or convexity depends on the size of the erect penis, its curvature angle and erectile function. Penile implant must be proposed to patients when erectile dysfunction is combined with severe curvature.

Shaping ability of nickel-titanium rotary instruments in curved root canals.

Disinfection and subsequent obturation of the root canal space require adequate mechanical enlargement of the canals. The purpose of this in vitro study was to compare the shaping ability of Mtwo, RaCe and Medin rotary instruments during the preparation of curved root canals. Sixty mesiobuccal root canals of mandibular molars with severe curvatures between 25-35(°) and radius of 4-9 mm were randomly divided into three groups of 20 canals each. Using pre- and post-instrumentation radiographs, straightening of the canal and the apical transportation were determined with AutoCAD software. The data were analyzed using Chi square, analysis of variance, and post-hoc tests and the significance level was set at P<0.05. Mtwo instruments maintained the canal curvature significantly better than Race and Medin instruments (P<0.05). There was significant difference between the rotary instruments for iatrogenic transportation of the major foramen (P>0.05). Under the conditions of this in vitro study, Mtwo instruments seemed superior to the two other rotary instruments.

Can Spongioplasty Prevent Fistula Formation and Correct Penile Curvature in TIP Urethroplasty for Hypospadias?

To clarify whether spongioplasty decreases the complications rate and the degree of penile curvature in TIP urethroplasty. From 2007 to 2011, 47 patients underwent TIP repair. Thirty-seven underwent spongioplasty, while 10 did not because their bifurcated spongy tissues could be not clearly identified. We investigated whether spongioplasty reduced the incidencerates of complications such as urethrocutaneous fistula. We also evaluated whether spongioplasty contributed to resolving or decreasing penile curvature. In addition, we assessed how many of the patients that underwent spongioplasty did not have to undergo dorsal plication. Among the 47 patients who underwent TIP repair, postoperative complications occurred in 3 (8%) of the 37 patients that underwent spongioplasty and 1 (10%) of the 10 who did not. Spongioplasty did not decrease the complications rate of TIP repair. As 15 of the 47 patients demonstrated a straight penis before spongioplasty, the effect of spongioplasty on the correction of penile curvature was analyzed in 32 patients. Dorsal plication was avoided in 19 patients (59%) because their penile curvature had been decreased to within the permissible range (<15°) by spongioplasty. We conclude that spongioplasty can not replace dartos flap coverage of the neourethra after TIP urethroplasty because it did not produce a significant reduction in the complications rate; however, spongioplasty could be used as an additional procedure because it reduced the degree of penile curvature and allowed dorsal plication to be avoided in more than half of the hypospadiac patients that displayed moderately severe curvature.

Severe Penile Curvature following Otis Urethrotomy

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

A comparison between conventional and digital radiography in root canal working length determination

Obtaining a correct working length is necessary for successful root canal treatment. The aim of this study was to compare conventional and digital radiography in measuring root canal working length. In this in vitro study 20 mesio buccal canal from maxillary first molars with moderate and severe curvature and 20 canal form anterior teeth with mild curvature were chosen and their working length were measured with number 15 k file (Maillefer, DENTSPLY, Germany). Then for each canal five radiographies were taken, three conventional radiographies using three methods of processing: Manual, automatic, and monobath solution; in addition to two other digital radiographies using CCD and PSP receptors. Two independent observers measured working length in each technique. Finally, the mean of working length in each group was compared with real working length using a paired T-test. Also a one-way ANOVA test was used for comparing the two groups. The level of statistical significance was P < 0.05. The results have shown that there was a high interobserver agreement on the measurements of the working length in conventional and digital radiography (P ≤ 0.001). Also there was no significant difference between conventional and digital radiography in measuring working length (P > 0.05). Therefore it was concluded that the accuracy of digital radiography is comparable with conventional radiography in measuring working length, so considering the advantages of the digital radiography, it can be used for working length determination.

A New Type of Growing Rod for the Treatment of Scoliosis

Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Source: Cheung KM, Cheung JP, Samartzis D, et al. Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Lancet. 2012; 379( 9830): 1967- 1974; doi: 10.1016/S0140-6736(12)60112-3[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Investigators from the University of Hong Kong and the San Diego Center for Spinal Disorders designed this prospective study in Hong Kong to determine the effectiveness and safety of a new magnetically controlled growing rod (MCGR) used to gradually distract or lengthen the spinal curvature in clinic in young growing children with scoliosis. The investigators inserted a single-use sterile titanium spinal distractible rod with an enlarged … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DCheung%26rft.auinit1%253DK.%2BM.%26rft.volume%253D379%26rft.issue%253D9830%26rft.spage%253D1967%26rft.epage%253D1974%26rft.atitle%253DMagnetically%2Bcontrolled%2Bgrowing%2Brods%2Bfor%2Bsevere%2Bspinal%2Bcurvature%2Bin%2Byoung%2Bchildren%253A%2Ba%2Bprospective%2Bcase%2Bseries.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252812%252960112-3%26rft_id%253Dinfo%253Apmid%252F22520264%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(12)60112-3&link_type=DOI [3]: /lookup/external-ref?access_num=22520264&link_type=MED&atom=%2Faapgrand%2F28%2F4%2F48.atom [4]: /lookup/external-ref?access_num=000304757700031&link_type=ISI

Congenital Penile Curvature: Update and Management

Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible, at which point surgical repair is recommended. Excellent outcomes can be expected with surgical intervention. The three most commonly used repair techniques are the original Nesbit procedure, modified Nesbit procedure, and plication. Nesbit and modified Nesbit techniques require that an incision is made in the tunica albuginea while plication techniques utilize plicating sutures without an incision. While Nesbit and modified Nesbit techniques are more complex operations, these generally result in less recurrences and more satisfactory outcomes as opposed to the quicker and simpler plication technique.

Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Cheung KM, Cheung JP, Samartzis D, et al. Lancet 2012;379(9830):1967–74. Epub 2012 Apr 19.

Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Cheung KM, Cheung JP, Samartzis D, et al. Lancet 2012;379(9830):1967–74. Epub 2012 Apr 19.

Penile Plication Without Degloving Enables Effective Correction of Complex Peyronie's Deformities

To present our initial experience with extended plication repair for men with severe and/or biplanar penile curvature. A review of men who underwent plication repair for complex penile deformity (biplanar curvature or curvature ≥ 60°) was performed. All patients underwent tunical plication via a 2-cm penoscrotal incision mobilized distally along the penile shaft without degloving. Angle of curvature, direction(s), stretched penile length (SPL), and number of sutures were recorded. Among 102 patients treated with plication surgery, 43 (44%) had complex penile deformity. Among 11 men with biplanar curvature, median angle in the primary plane of curvature was corrected from 45° to 10° and secondary plane was corrected from 35° to 5° using an average of 7 sutures (5° correction per suture). Among 32 men with severe curvature, median angle of curvature was corrected from 70° to 15° using an average of 11 sutures (6° correction per suture). SPL was unchanged in 29 (69%), increased an average of 0.65 cm in 7 (16%), and decreased 0.5 cm in only 6 (14%) patients. At a mean follow-up of 15.3 months, repeat plication was required in 2 patients and 2 required penile prosthesis. Penile plication without degloving appears to be safe and effective for correction of complex penile curvature without significant impact on penile length.