Treatment Of Congenital Penile Curvature Research Articles

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood?

ObjectiveTo compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood. Materials and methodsForty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups. ResultsMean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047). ConclusionThe use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

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

P-02-37 Surgical Treatment of Congenital Penile Curvature Using a Modified Excisional Corporoplasty Technique

P-02-37 Surgical Treatment of Congenital Penile Curvature Using a Modified Excisional Corporoplasty Technique

Long-Term Results after Surgical Treatment of Congenital Penile Curvature Using a Modified Nesbit Technique.

PurposeCongenital penile curvature (CPC) is a rare condition with surgical correction being the standard therapy. In the current study, we report long-term results analyzing the surgical and functional outcomes using a modified Nesbit technique.Materials and MethodsPatients with CPC were included. After penile degloving and mobilization of the neurovascular bundle an artificial erection was performed. An ellipsoid part of the tunica albuginea was excised at the point of maximum curvature on the convex side of deviation. The tunical defect was then closed by interrupted absorbable sutures with inverted knots. Results of correction were documented intra- and postoperatively by artificial erection. Pre- and postoperative evaluation included measurement of penile length and curvature after pharmacological erection. Erectile function, alteration in glans sensation, palpable suture as well as short- and long-term complication were also recorded using validated questionnaires and objective examinations.ResultsFifty-five patients with mean age 26.93 years (14–66 years) and mean curvature 69.81° (25°–90°) were included in the study. Ventral or ventrolateral curvature was observed in 83.6%. Mean operative time was 106.8 minutes (55–169 minutes). Totally straightness of the penis was achieved in 51/55 patients (92.8%). After a mean long-term follow-up of 36.68 months (4–87 months), erectile function worsened in 3.6% of patients. Median penile length loss associated with this technique was 1.7 cm (0–3.0 cm).ConclusionsSurgical therapy of CPC using our modified Nesbit technique is feasible, safe and provides reliable long-term outcomes, representing an alternative for surgical correction of CPC.

Current trends in the surgical treatment of congenital penile curvature.

Congenital penile curvature (CPC) is a relatively uncommon condition, characterized by congenital angulation of the erect penis. Surgical correction of CPC is the gold standard therapy with a variety of proposed surgical techniques and modifications. This review summarizes the contemporary literature on the surgical management of CPC, trying to address the current trends, as well as the advantages and disadvantages of available methods. We performed a non-systematic narrative and interpretative literature review until December 2018. We included articles with isolated CPC in human adults. We excluded original research articles regarding the surgical treatment of Peyronie's disease (PD). In total, we identified 34 studies including 2155 patients with CPC that met our inclusion criteria. Nine studies included patients with both CPC and PD, but reported sufficient data regarding the CPC cohort. Excisional corporoplasty and incisionless plication seemed to be the preferred surgical methods (10 and 12 studies, respectively), followed by incisional corporoplasty (5) and grafting (3). Four studies reported results of more than one method. Overall, patients with CPC can expect excellent outcomes with surgical repair and minimal side effects. No definite conclusions can be made regarding which technique is superior. The widely varied outcomes highlight the need for standardized outcomes measures in future research.

Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment

Penile corporoplasty is a well-established treatment method of congenital penile deviation (CPD). Anatomical results are good with only slight differences between surgical procedures used. The disease however has huge influence on young male quality of life. This issue is not well analyzed in the literature. The aim of the study was to evaluate quality of life of the patients affected with CPD before and after the surgical treatment Study population consisted of 107 patients with CPD referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function. Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method. CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being.

Corporoplasty plication surgery for the treatment of congenital penile curvature

Corporoplasty plication surgery for the treatment of congenital penile curvature

Rotation of the corpora cavernosa for the treatment of congenital penile curvature

IntroductionCongenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. Material and methodsWe present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. ResultsThe surgical time was 120min and there were no intraoperative complications. Both patients were discharged 24h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1cm and the International Index of Erectile Function-5 was 25 for both cases. ConclusionsSurgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

A new corporoplasty based on stratified structure of tunica albuginea for the treatment of congenital penile curvature - long-term results.

IntroductionThe aim of the study was to report long–term results of treatment of patients with congenital penile curvature (CPC) with a new corporoplasty based on stratified structure of tunica albuginea, in which corporal bodies are not opened.Material and methodsFrom October 2006 to September 2013, the authors operated on 111 adult men with CPC. Ventral curvature was detected in 65 patients, lateral in 34, and dorsal in 12. Skin was incised longitudinally on convex surface of curvature. In ventral curvature, dorsal neuro–vascular bundles (NVBs) were separated from tunica albuginea and elliptical fragments of external (longitudinal) layer of tunica were excised. The tunica was sutured with absorbable sutures, which invaginated the internal (transversal) layer of tunica. In dorsal curvature, excisions were performed on both sides of the urethra, in lateral curvature – on the convex penile surface.ResultsFollow–up period was from 12 to 84 months. The penis was completely straight in 109 out of 111 patients. In 2 patients (1.8%) recurrent curvature of up to 20 degrees was detected. Redo surgery was done in one individual (0.9%) at patient‘s request. Glandular sensation loss or erectile dysfunction was not detected in any patient during the period of observation.ConclusionsA new operation for correction of CPC, which consists of excision of an elliptical fragment of the external layer of the tunica albuginea and plication of the internal layer gives good short and long–term results. Surgery done without penetrating the corpora cavernosa is minimally invasive, which diminishes the potential risk of complications, especially intra– and postoperative bleeding.

809 Late results after a new little-invasive corporoplasty based on stratified structure of tunica albuginea for the treatment of congenital penile curvature

809 Late results after a new little-invasive corporoplasty based on stratified structure of tunica albuginea for the treatment of congenital penile curvature

The last developments about the diagnosis and treatment of congenital penile curvature (chordee)

The last developments about the diagnosis and treatment of congenital penile curvature (chordee)

New plication technique for the treatment of congenital penile curvature.

Introduction: Conditions that cause curvature of the erect penis also lead to difficulties with intercourse. The present study presents an effective surgical treatment for congenital penile curvature. Methods: Between March 1996 and August 2004, 49 patients were diagnosed with congenital penile curvature at the Toho University Omori Hospital Reproduction Center, Tokyo. Of these, 27 eligible patients underwent surgical treatment. The operative technique used involved the tunica albuginea being exposed and a number of vertical incisions were made through its superficial layers. The superficial layer of the tunica albuginea was then resected using scissors. Inverted plication sutures were then placed in the raw surface of the corpus cavernosum using 2-0 nylon. In addition, 2-0 polyglactic acid (Vicryl) sutures were placed on either side of each nylon suture knot. Results: Of a total of 49 patients, 27 eligible patients underwent surgical treatment with no serious postoperative complications. All 27 patients were able to sustain intercourse. There were no new cases of erectile dysfunction, penile pain or penile shortening. There were no recurrences of penile curvature. Conclusions: This new partial thickness shaving, inverted sutures reinforced with dissolving sutures plication method is an extremely effective surgical treatment for congenital penile curvature, with a superior safety profile. (Reprod Med Biol 2005; 4: 255-258).

Nesbit method in surgical treatment of congenital penile curvature in young men

Nesbit method in surgical treatment of congenital penile curvature in young men

Corporeal Plication for the Treatment of Congenital Penile Curvature

Corporeal Plication for the Treatment of Congenital Penile Curvature

Corporeal Plication for the Treatment of Congenital Penile Curvature

Corporeal Plication for the Treatment of Congenital Penile Curvature

ULTRASTRUCTURE OF THE TUNICA ALBUGINEA IN CONGENITAL PENILE CURVATURE

We investigated the ultrastructure of the tunica albuginea in individuals with congenital penile curvature to explain the pathology of this disease. Included in our study were 15 patients 17 to 24 years old with congenital penile curvature. Study material consisted of samples of the tunica albuginea excised from the greater curvature of the corpus cavernosum during surgical correction. Control samples were obtained from the lesser curvature on the side opposite the study material during the same operation. The 2 types of tissue were analyzed using transmitter electron microscopy. Ultrastructural examination of the control material revealed numerous collagen fibers that were homogenous in size and organization on cross section. Periodic striation was typical in collagen that produced fibers. In the study group the tunica albuginea structure had a chaotic pattern of collagen fibers that formed bundles with disrupted 3-dimensional organization. Diameter of the fibers differed greatly on cross section. We observed periodic widening and fragmentation of collagen fibers with the complete disappearance of striation and transformation into electron dense, fibrous granulated material. Disrupted fibroblasts without cell membrane and cellular organelles between collagen fibers were also visible. There was elastin accumulation without any morphological differences in the control and study groups. Our results show that ultrastructural changes in the tunica albuginea may cause congenital penile curvature, possibly by altering mechanical properties.

Treatment of Congenital Penile Curvature with Penile Torsion: A New Twist

Congenital penile curvature secondary to asymmetry of corpora cavernosal length is an uncommon cause of penile deformity. Although the deformity generally is not severe enough to preclude sexual intercourse it can be a source of great concern to the patient and may cause him to avoid all sexual contact. The Nesbit procedure is a simple, effective surgical technique to correct lateral or ventral curvature. Rarely penile deviation is accompanied by penile torsion. This unique problem requires a novel surgical approach to create a straight, nontwisted erection. We report 2 cases of congenital lateral penile curvature with accompanying penile torsion and describe a simple modification of the Nesbit procedure for surgical correction.

Treatment of Congenital Penile Curvature Due to Disparate Corpora Cavernosa by the Nesbit Technique: A Rule of Thumb for the Number of Wedges of Tunica Required to Achieve Correction

Treatment of pure congenital penile curvature due solely to asymmetry of the corpora cavernosa as described by Nesbit lacks precision. Intraoperative verification of Nesbit correction by artificial erection after wedge excision may be impossible because leakage through the sutured corporeal incisions prevents full erection. We present a rule of thumb to calculate the number of 1cm. wedges of tunica albuginea to be excised to correct an individual deformity. The number of such wedges required is equal to the measured difference in centimeters between the lengths of the asymmetric, concave and convex surfaces of the affected penis, between the pubis and mid glans. Results of application of this principle in 6 patients are presented.