Surgical Correction Of Penile Curvature Research Articles

(171) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique

Abstract Introduction Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. Objective We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. Methods A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4–0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3–0 Vycril suture. Results This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Conclusions Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. Disclosure No.

(192) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique

Abstract Introduction Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. Objective We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. Methods A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4-0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3-0 Vycril suture. Results This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Conclusions Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. Disclosure No.

Prepuce-sparing corporoplasty as a safe alternative for patients with acquired penile curvature

penile curvature is a rare condition, classified as congenital or acquired (Peyronie's disease) (PD). Surgical correction is the standard treatment. It's common practice to associate circumcision with penile de-gloving to prevent complications. In this paper we evaluate the feasibility of penile surgery avoiding circumcision. patients presenting with penile curvature were treated using a modified Nesbit procedure. Patients were divided into group A if they opted for a prepuce-sparing surgery and the others into group B. Patients were evaluated pre and postoperatively and postoperative complications were assessed. The 5-item International Index of Erectile Function (IIEF-5) was administered before and 6 months after surgery and we compared the difference of mean value using T-Test. Group A and B were made of 53 and 16 patients respectively. Median age was 59 years [interquartile range (IQR) 12] in A and 62 (IQR 9) in B (p = 0.2). Median curvature was 40° (IQR 40°) in A and 40 ° (IQR 30°) in B (p = 0.62). Mean difference between pre- and post-operative IEFF was 1.9 ± 2 in A and 2.6 ± 2.1 in B (p = 0.36). According to our experience, surgical correction of penile curvature without performing circumcision could be a safe and feasible strategy. We recommend performing circumcision only in patients who present with pre-operative phimosis.

Prevalence, assessment and surgical correction of penile curvature in hypospadias patients treated at one European Referral Center: description of the technique and surgical outcomes.

Penile curvature (PC) is a common component of hypospadias, but its presence is inconstantly assessed. We aim to report prevalence of PC in hypospadias patients, as well as to report our method to assess and correct PC, with the associated postoperative outcomes. We scrutinized 303 pediatric hypospadias patients operated (2013-2018) at our referral center. PC was routinely assessed and eventually corrected with dorsal plications (DP) as one-stage procedure, or ventral tunica attenuations ± DP as two-stage repair. PC severity and surgical treatment of PC were compared between primary and failed hypospadias. Finally, PC severity, failed repair and PC treatment were tested as predictors of perioperative complications. PC (> 10°) was identified in 274/303 (90.4%) patients, 86.1% with distal, 91.8% with midshaft, and 100% with proximal hypospadias, respectively. PC was found in 51/64 (79.7%) of failed hypospadias. One-stage and two-stage procedures were adopted in 211/274 (77%) and 63/274 (23%) children, respectively. PC severity (p = 0.1) and PC treatment (p = 0.4) did not differ between primary and failed hypospadias. PC severity (all p > 0.2), failed repair (p = 0.8), and PC treatment (all p > 0.09) were not predictors of perioperative complications. 95.6% of patients achieved a straight penis. Less than 1/10 patients did not require PC correction. High rate of residual PC in failed hypospadias and similar severity between failed and primary suggest that PC was usually under-corrected. It is possible to correct PC completely and the resulting complication would not be associated with PC severity, failed repair or treatment adopted.

Outcomes of Surgery in Peyronie's Disease Following Intralesional Collagenase Clostridium Histolyticum Injections.

To explore the potential hurdles surgeons may encounter when preforming surgical correction of penile curvature in patients with Peyronie's Disease following intralesional collagenase clostridium histolyticum injections. Although limited data exists, retrospective analysis of surgeon experiences in surgical treatment of refractory penile curvature in patients with Peyronie's disease appears to not result in more post-operative complications and may only slightly increase intra-operative difficulty. As the use of intralesional collagenase clostridium histolyticum continues to increase and patients who demonstrate persistent curvature despite treatment seek further management, the role of investigating the feasibility of surgery demonstrates significant importance. Although limited data exists, it appears that surgery following intralesional collagenase clostridium histolyticum is safe without added post-operative complications. At the present time, however, further data on intra-operative findings and post-operative outcomes remain necessary, and as the use of this intralesional therapy continues to rise, further information should become readily available.

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.

PD44-11 COMPARISON OF PATIENT'S SATISFACTION AND LONG TERM RESULTS OF TWO PLICATION TECHNIQUES: LESSONS LEARNED FROM 387 PATIENTS WITH PENILE CURVATURE

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018PD44-11 COMPARISON OF PATIENT'S SATISFACTION AND LONG TERM RESULTS OF TWO PLICATION TECHNIQUES: LESSONS LEARNED FROM 387 PATIENTS WITH PENILE CURVATURE Selahittin Çayan, Ramazan Asci, Ozan Efesoy, Fatih Kocamanoglu, Erdem Akbay, and Önder Yaman Selahittin ÇayanSelahittin Çayan More articles by this author , Ramazan AsciRamazan Asci More articles by this author , Ozan EfesoyOzan Efesoy More articles by this author , Fatih KocamanogluFatih Kocamanoglu More articles by this author , Erdem AkbayErdem Akbay More articles by this author , and Önder YamanÖnder Yaman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2135AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the study was to compare the patient′s satisfaction and long-term results of two plication techniques in patients with penile curvature. METHODS The study included 387 patients who underwent surgical correction of penile curvature with penile plication in three tertiary university hospitals. Of the patients, 260 had congenital penile curvature, and 127 had Peyronie′s disease. Related to the surgical procedure, 202 patients underwent plication of tunica albuginea with Lue′s sixteen-dot technique, while 185 patients underwent tunica albuginea excision with traditional Nesbit technique. Surgical outcomes and patient′s satisfaction were compared between the two techniques in all patients. RESULTS The mean age and follow-up period of the patients were 34 years (range 16 to 81) and 41 months (range 6 to 144), respectively. The mean angle of deformity was 42 degrees (range 30 to 80). The rates of early complications, including superficial wound infection, hematoma and urethral injury were similar and very low in the both techniques. Mean duration of surgery was significantly shorter in the 16-dot plication technique (48 minutes), compared with the Nesbit technique (63 minutes) (p=0.001). Outcomes of the two surgical procedures are shown in the table, regardless of their etiology of penile curvature. The rates of penile sensory loss and de-novo erectile dysfunction were significantly higher in the Nesbit technique than in the 16-dot plication technique, but rate of palpable bumps or knots under the penile skin was significantly higher in the 16-dot plication technique than in the Nesbit technique. Regardless of the surgical techniques, the patients with congenital penile curvature had significantly less postoperative de-novo erectile dysfunction than Peyronie′s disease patients. CONCLUSIONS 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 two surgical procedures. Therefore, patients with penile curvature should be informed about surgical outcomes, and surgical method for penile curvature should be preferred based on surgeon′s experience and patient′s preference. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e885 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Selahittin Çayan More articles by this author Ramazan Asci More articles by this author Ozan Efesoy More articles by this author Fatih Kocamanoglu More articles by this author Erdem Akbay More articles by this author Önder Yaman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Plication procedures-excisional and incisional corporoplasty and imbrication for Peyronie's disease.

Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD.

S&T-51 EXTRACELLULAR MATRIX CHARACTERISTICS OF TUNICA ALBUGINEA IN MEN WITH AND WITHOUT PEYRONIE'S DISEASE

INTRODUCTION AND OBJECTIVES: Peyronie’s disease (PD) is characterized by the formation of fibrous plaques in the tunica albuginea (TA) of the penis, causing pain and penile curvature during erection, with great impact on quality of life of patients. There is a lack of highly effective medical treatments for PD, mainly because it’s pathophysiology is not completely understood. The aim of this study was to compare possible markers related to alterations and remodeling of extracellular matrix which can be involved on the development of the disease in men with and without PD METHODS: Samples of TA of 10 patients with PD were obtained at the moment of surgical correction of penile curvature. Samples of TA of 10 corpses with normal penis at the physical exam were obtained (control group). Tissues were processed and stained with Hematoxilin, submitted to immunohistochemistry (IHQ) with the following primary antibodies: heparanase (HPSE), heparanase2 (HPSE2), metalloproteinases 2 and 9 (MMP2 and MMP9) and TGF-s. IHQ reaction used peroxidase kit LSAB -peroxidase (DakoCytomation , Copenhagen, Dinamarca). Genic expression of heparanase-1 (HPSE), heparanase2 (HPSE2), metalloprotease 9 (MMP9), syndecan 1 (SYN1), interleukin 6 (IL-6), hyaluronic acid sintetase 1 e 2 (HAS1 e HAS2), hyaluronidases 1 e 2 (HYL1 e HYL2), was done by quantitative RTPCR (qRT-PCR). Statystical analyses were done using software Graph PRISM 5 . Project was reviewed and approved by the Research Ethical Committee of Faculdade de Medicina do ABC, (# 242/2010). RESULTS: Histopathological evaluation showed higher number of cells, reduction of apoptosis events, alteration of the distribution of collagen fibers and diminished number of vessels on TA of patients with PD compared to the controls TA. qRT-PCR analysis showed increased concentration of TGF-s and interleucine1 reduction on HSPE-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate in patients with PD (p<0.05). However, there were no alterations on HPSE2, MMP2 e MMP9 expressions. Those findings suggest a higher remodeling of extracellular matrix in patients with PD. CONCLUSIONS: In comparison with the controls the TA of patients with PD showed lesser number of vessels and apoptosis events; increased concentration of TGF-s and interleukin-1, reduction of heparanase-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate.

S&T-52 EARLY CHANGES IN SKELETAL MUSCLE AS A STRONG PROGNOSTIC BIOMARKER IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVES: Peyronie’s disease (PD) is characterized by the formation of fibrous plaques in the tunica albuginea (TA) of the penis, causing pain and penile curvature during erection, with great impact on quality of life of patients. There is a lack of highly effective medical treatments for PD, mainly because it’s pathophysiology is not completely understood. The aim of this study was to compare possible markers related to alterations and remodeling of extracellular matrix which can be involved on the development of the disease in men with and without PD METHODS: Samples of TA of 10 patients with PD were obtained at the moment of surgical correction of penile curvature. Samples of TA of 10 corpses with normal penis at the physical exam were obtained (control group). Tissues were processed and stained with Hematoxilin, submitted to immunohistochemistry (IHQ) with the following primary antibodies: heparanase (HPSE), heparanase2 (HPSE2), metalloproteinases 2 and 9 (MMP2 and MMP9) and TGF-s. IHQ reaction used peroxidase kit LSAB -peroxidase (DakoCytomation , Copenhagen, Dinamarca). Genic expression of heparanase-1 (HPSE), heparanase2 (HPSE2), metalloprotease 9 (MMP9), syndecan 1 (SYN1), interleukin 6 (IL-6), hyaluronic acid sintetase 1 e 2 (HAS1 e HAS2), hyaluronidases 1 e 2 (HYL1 e HYL2), was done by quantitative RTPCR (qRT-PCR). Statystical analyses were done using software Graph PRISM 5 . Project was reviewed and approved by the Research Ethical Committee of Faculdade de Medicina do ABC, (# 242/2010). RESULTS: Histopathological evaluation showed higher number of cells, reduction of apoptosis events, alteration of the distribution of collagen fibers and diminished number of vessels on TA of patients with PD compared to the controls TA. qRT-PCR analysis showed increased concentration of TGF-s and interleucine1 reduction on HSPE-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate in patients with PD (p<0.05). However, there were no alterations on HPSE2, MMP2 e MMP9 expressions. Those findings suggest a higher remodeling of extracellular matrix in patients with PD. CONCLUSIONS: In comparison with the controls the TA of patients with PD showed lesser number of vessels and apoptosis events; increased concentration of TGF-s and interleukin-1, reduction of heparanase-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate.

Do adult men with untreated ventral penile curvature have adverse outcomes?

Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p < 0.001), more unhealthy mental days (8.6 vs 6.2, p = 0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p < 0.001). Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood.

International multicentre psychometric evaluation of patient-reported outcome data for the treatment of Peyronie's disease.

To compare patient-reported outcomes (PROs) of surgical correction of Peyronie's disease (PD) with the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant after surgical correction of penile curvature. We performed a retrospective review of men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment-related PROs and satisfaction were evaluated with a non-validated questionnaire. The response rate to the questionnaire was 70.9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 patients, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD preoperatively (range 2.1-3.2 cm). Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range 0.4-1.2 cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by the loss of length. Penile length loss due to PD affects most patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.

Postoperative pulmonary edema secondary to rapid fluid injection into the corporal bodies during surgical correction of penile curvature: a rare consequence of artificial erection

Some experts contend that occlusion of the proximal corpora cavernosal bodies of the penis with a tourniquet or manual compression during induction of an artificial erection distorts the penile anatomy and potentially masks proximal curvatures. The current report highlights a rare, but potentially morbid, case of postoperative pulmonary edema as a consequence of rapid fluid injection into the corporal bodies during surgical correction of penile curvature, in a 48-year-old male with a high-risk cardiac history.

Surgical treatment of Peyronie's disease by modified 16-dot placation in China.

ObjectiveTo assess the long-term patient’s satisfaction and functional results of surgical correction for Peyronie’s disease (PD) patients with penile curvature by 16-dot minimal tension placation and its modification in Chinese population.Patients and methodsBetween August 2004 and December 2008, 32 patients with PD underwent surgical correction of penile curvature by 16-dot minimal tension placation and its modification. Indications for operation included PD patients with penile curvature, adequate erectile capacity, difficulty or inability to vaginal penetration. Preoperative evaluation included International Index of Erectile Function 5 (IIEF-5) questionnaire score, pain on erection and physical examination. Patients were recommended daily low dose phosphodiesterase type 5 (PDE5) inhibitors two weeks after surgery and maintained for two months. At follow-up, patients and partner’s satisfaction and erectile function were assessed by IIEF-5 questionnaire score.ResultsThere were no surgery-related complications, and 94% of patients and 88% of partners reported overall satisfaction after the surgery. Complete penile straightening was achieved in 27 (84%) patients. Slight residual curvatures were observed in 4 patients, which did not affect their sexual intercourse. All patients were satisfied with postoperative penile length while shortening of the penis was noted in 13 patients (40%) with median penile length loss of 1.5 cm. In addition, no de novo erectile dysfunction was observed, and sexual function was significantly improved evidenced by the IIEF-5 scores, especially in the patients who have received PDE5 inhibitors for two months after two weeks surgery.ConclusionsCorrection of penile curvature using 16-dot placation and its modification is a simple and safe method to achieve cosmetic and functional satisfaction in carefully selected PD patients.

Sensory changes after surgical correction of penile curvature

In 32 men (mean age 54.94 years, range 25-70 years), thresholds for penile thermal and vibratory sensation were recorded before and 3 months after surgery using a genital sensory analyser. The following significant changes were found postoperatively. The cold threshold decreased in the glans from 27.24 to 25.33 degrees C (P<0.001) in men older than 60 years, and in the ventral penile shaft from 28.54 to 25.46 degrees C (P<0.001) in men aged 35-59 years. The warm threshold increased in the glans from 38.31 to 40.61 degrees C (P=0.002) in men aged 35-59 years, and from 39.20 to 40.58 degrees C in men older than 60 years (P=0.023). The warm threshold also increased in the ventral penile shaft in men aged 35-59 years, from 36.62 to 37.82 degrees C (P=0.023). For all three age groups combined, the vibratory threshold changed in the glans from 2.33 to 2.93 mum (P<0.001). It is concluded that penile sensitivity changed significantly after surgery for penile curvature treatment, regardless of whether a ventral or dorsal surgical approach is used.

Incidence of penile curvature in various forms of hypospadias

Hypospadias is a congenital anomaly of the penis, characterised by ectopically positioned urethral meatus and associated anomalies (cryptorchidism, inguinal hernia, penile curvature). Proximal forms of hypospadias, as severe cases, are particularly accompanied by penile curvature (chordee). Distal types are considered to be mild degrees. To determine the incidence of congenital curvature within various forms of hypospadias in order to signify preoperative and intraoperative diagnosis of chordee as a part of hypospadias repair. The total of 454 patients with hypospadias were treated surgically in a five-year period (2001-2006.) at the University Children's Hospital of Belgrade. The patients were divided into two groups according to the surgeon who had treated them. Only the first group of patients was tested for chordee as a part of standard procedure and complete treatment. In both groups we analyzed the number of patients treated for penile curvature within various types of hypospadias. We also compared scores in the two groups using Fisher test and chi2-test. Scanning retrospective, 104 cases (22.9%) of diagnosed and surgically corrected chordee were determined. In 31.6% of patients from the first group and 11.6% of patients from the second group we diagnosed and corrected some form of penile curvature was. Chordee was significantly more frequent in the first group, regarding hypospadias in general (p<0.01), as well as distal (p<0.05) and mid shaft forms (p<0.01). Penile curvature is not uncommon in hypospadias. In this study we report a significantly higher frequency as related to the patients in the second group who were not tested for curvature during hypospadias treatment. This is why standard techniques in hypospadias repair should definitely include the diagnosis and surgical correction of penile curvature.

Long-term patient satisfaction after surgical correction of penile curvature via tunical plication

To assess patient satisfaction and functional results at long term follow-up after surgical correction for Peyronie's disease (PD) and congenital penile curvature (CPC) with the technique of tunical plication. One hundred and two men operated for PD (n = 76) or CPC (n = 26) in four different departments of urology in public hospitals agreed to answer a six-question telephone questionnaire about treatment satisfaction. Tunica albuginea plication procedures represented the standard surgical approach. Subjects under investigation were correction of the deformity, feeling of bumps under the skin, pain during erection, penile sensory changes, development of erectile dysfunction (ED) and postoperative ability for complete vaginal intromission. Subjective response rates were compared using the chi square test on the basis of the etiology of the disease (CPC or PD). Significant differences (p < 0.05) between patients with CPC and PD were noticed in the prevalence of postoperative penile deformity, sensory changes, ED and ability to complete vaginal intromission, PD patients always showing a more pessimistic view. No significant differences (p = ns) were detected in terms of unpleasant nodes under the penile skin or pain during erection. Long-term outcome after surgical correction for PD and CPC with the technique of tunical plication can be poor. Probably patient expectations are above the real performance of surgical techniques. Preoperative information should be more exhaustive.

Long-Term Cosmetic and Sexual Outcome of Hypospadias Surgery: Norm Related Study in Adolescence

Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.

Factors Affecting the Loss of Length Associated With Tunica Albuginea Plication for Correction of Penile Curvature

Loss of length is a common postoperative complaint of the patient who undergoes surgical correction of penile curvature. We investigate the factors influencing complications in patients who have undergone TAP for PD and chordee. A total of 102 patients underwent TAP for PD (68) or chordee (34) between 1997 and 2004. Data were gathered on each patient's preoperative complaints, physical examination, Doppler ultrasound, operative data and postoperative complaints. For the purposes of this study penile length was measured from pubis to corona along the dorsal surface of the stretched phallus. Mean ages at surgery for men with PD and chordee were 53 and 24, respectively. A range of 1 to 6 plications were performed on each patient (mean 3) with an acceptably straight penis (curve less than 20 degrees) being achieved in 99% of patients. Mean followup for our patient population was 29 months and revealed only 1 patient with residual curvature. The mean loss in length after TAP was 0.36 +/- 0.5 cm with a range of 0 to 2.5 cm. When calculated as a percent of length lost from preoperative length, the postoperative percent length lost was 2.4%. When stratified into groups based on direction of curvature, the patients with ventral or ventrolateral curve had the highest percent loss of length. A 1-way ANOVA of these groups proved the differences between each group to be statistically significant (p = 0.04). Length change also significantly correlated with preoperative stretched penile length and the severity of curvature as measured in degrees in the operating room at time of surgery. Parameters that did not demonstrate a statistically significant impact on penile shortening included patient age, number of plications performed, plaque size, and hinge/narrowing effect due to a PD plaque. The TAP procedure is a safe and effective means of correcting penile curvature, with similar overall outcomes between patients with PD and chordee. Shortening of the penis does commonly occur but is dependent on direction and degree of curvature, as well as the length of the phallus.

Corrección del pene curvo en cirugía mayor ambulatoria

ObjectiveOTo evaluate the results obtained in the correction of the curved penis by means of Nesbit’s technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital Patients and methodFrom January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie´s disease) by means of Nesbit’s technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire ResultsNone of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient’s process. The degree of satisfaction with the received treatment has been superior to 95% ConclusionsThe practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patients’s satisfaction