Ventral Penile Research Articles

Retrograde Progression of Inner Preputial Skin to Overcome Skin Shortage in Cases of Congenital Buried Penis.

The aim of this study is to report our experience in the treatment of congenital buried penis using a simplified technique of retrograde progression of inner preputial skin for reconstruction and overcome skin shortage. This is a retrospective multi-institutional study conducted in the Department of Pediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India, and the Department of Paediatric Surgery, Rajiv Gandhi Super Specialty Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India, over a period of 3 years (from March 2019 to February 2022). A total of 14 cases of primary congenital buried penis were operated in the specified period. Age of the patients ranged between 8 months and 9 years. Retrograde progression of the inner preputial skin to provide coverage to the dorsal aspect of penile shaft and ventral transposition of the dorsal penile skin to cover the ventral penile shaft was used as a standard procedure for skin coverage. All patients had good-to-excellent outcomes with uniformly improved visualisation of penile shaft post-operatively. There were no significant post-operative complications apart from mild oedema which subsided over a period of 3 weeks. Genital hygiene had significantly improved in all the patients as a result of uninterrupted urinary stream. Retrograde progression of the inner preputial skin may be used as an effective technique to provide skin coverage to the penile shaft for reconstruction of congenital buried penis. It provides good functional and cosmetic results with adequate parental and patient satisfaction with minimal complications.

Late chordee correction after tubularized incised plate repair for proximal hypospadias: An underreported problem

AbstractBackgroundRepair of proximal hypospadias remains a challenge with no consensus on the best surgical approach. Several reports have shown recurrence of chordee after plate‐preserving techniques. In this report, we present our experience in managing cases who presented with persistent/recurrence of chordee after tubularized incised plate (TIP) repair for proximal hypospadias.MethodsBetween 2015 and 2023, the study included eight patients who presented with ventral penile curvature after previous hypospadias repair in infancy (TIP urethroplasty). Reoperation to correct persistent ventral curvature was performed several years after the primary TIP repair (3–15 years; mean 7.9 years; median 7.5 years). The reoperation was a two‐stage procedure: the first stage comprised transection of the urethra and grafting (lower lip mucosal graft); the second stage (6 months later) was a Thiersch‐Duplay urethroplasty.ResultsComplications included poor taking of the graft after the first stage in one case (12.5%), which was regrafted using buccal (cheek) mucosa. Complications after second stage included urethro‐cutaneous fistulae in five (62.5%) that were successfully surgically treated at a later stage. Follow‐up after second stage ranged between 6 months and 7 years (mean 2.4 years; median 1 year). Satisfaction with reoperation to correct penile curvature was noted by parents as well as older children (adolescents) who appreciated better cosmesis by increasing ventral penile length and improved curvature.ConclusionPreservation of the urethral plate in proximal hypospadias may result in shortened penile length, mostly on the ventral aspect. A two‐stage reoperation to increase the length of the penile urethra can successfully reverse this complication.

(167) Shaeer’s Corporal Rotation IV: Length and Girth Preserving Technique for Correction of Severe Congenital Ventral Penile Curvature

Abstract Introduction For cases with severe penile curvature, the loss in length with shortening techniques, or the loss in rigidity with incision-grafting can compromise the results, hence the advent of Shaeer’s Corporal Rotation III technique which corrects the most severe degrees of ventral penile curvature without loss in length, though with a certain degree of narrowing. Objective To describe Shaeer’s Corporal Rotation IV, aiming at correction of moderate to severe ventral penile curvature with minimal shortening, minimal narrowing, minimal mobilization of the neurovascular bundle, among other improvements such as using thicker suture material to decease recurrence while inverting the surgical knots. Methods Forty-two patients with congenital ventral penile curvature were selected for the study with the curve ranging from 60 to 90 degrees. Patients were randomized into one of the two groups: Shaeer’s Corporal Rotation III (SCR-III) and Shaeer’s Corporal Rotation IV (SCR-IV). In SCR-IV, rotation is used to correct the main brunt of curvature, up to 70–80% of the curve. Plication is used to correct the residual curvature up to 100% straightness. This keeps the rotation points fewer and closer to the midline, thereby minimizing narrowing and mobilization of the neurovascular bundle. Both groups were compared as regards intra-operative erection angle, length and girth, before and after rotation, as well as subjectively-reported post-operative recurrence, penile sensitivity, satisfaction and IIEF. Results Post-correction angle was zero for all cases in the two groups. Dorsal length decreased by 3% in SCR-IV, compared to 0.5% in SCR-III (2.5% difference). The difference in circumference between narrowest and widest points was 2% in SCR-IV versus 9.3% in SCR-III (7.3% difference). Average operative time was 19.2% shorter with SCR-IV. Girth asymmetry was reported in 1/21 patients in SCR-IV (4.8%), compared to 15/21 in SCR-III (71.4%). Partial hyposensitivity of the penis was reported in 9.5% among SCR-IV compared to 19% in SCR-III. Conclusions Shaeer’s Corporal Rotation IV technique corrects moderate and severe degrees of congenital ventral penile curvature, with little or no compromise in penile length, girth or sensitivity. Disclosure No.

(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.

Surgical repair of a ventral penile fracture: a case report

Ventral fracture of the penis, although rare, is a medical emergency requiring immediate attention. This injury usually results from direct trauma to the erect penis and can lead to serious complications if not treated promptly. Initially, it requires an attentive clinical assessment and habitually, it is completed with ultrasound to characterize more the fracture and help with the surgical approach. Through this case report, we will present a case about a delicate localization of the fracture, and we will discuss the causes, symptoms, diagnosis and treatment options for this condition.

Surgical Repair of a Ventral Penile Fracture: A Case Report

Ventral fracture of the penis, although rare, is a medical emergency requiring immediate attention. This injury usually results from direct trauma to the erect penis and can lead to serious complications if not treated promptly. Initially, it requires an attentive clinical assessment and habitually, it is completed with ultrasound to characterize more the fracture and help with the surgical approach. Through this case report, we will present a case about a delicate localization of the fracture, and we will discuss the causes, symptoms, diagnosis and treatment options for this condition.

Outcomes of collagenase Clostridium histolyticum in men with ventral curvatures: an updated series.

The efficacy and safety of collagenase Clostridium histolyticum (CCH) have been demonstrated in the treatment of men with Peyronie's disease (PD); however, the pivotal clinical trials excluded men with ventral penile curvature. The study sought to evaluate outcomes of CCH treatment in men with ventral curvatures secondary to PD. Men with PD treated with CCH were identified from a prospective database. Patients received up to 4 series of CCH injections using a progressively modified protocol over time. Results were compared between those with baseline ventral vs nonventral penile curvatures. Changes in penile curvature, Peyronie's Disease Questionnaire scores, International Index of Erectile Function scores, nonstandardized assessments, and adverse events. A total of 560 men with PD (85 ventral curvature, 475 nonventral curvature) were included in the analysis. Baseline median curvature was 60.0° (interquartile range, 48.8°-75.0°) in the ventral cohort and 65.0° (interquartile range, 45.0°-80.0°) in the nonventral cohort. Median change from baseline penile curvature was -25.0° in the ventral cohort vs -24.0° in the nonventral cohort (P = .08, between-group comparison), which corresponded to curvature reductions of 44.7% and 33.6%, respectively (P = .03). In the subset of patients who completed CCH treatment (ie, received 8 injections or discontinued early because of patient satisfaction with curvature reduction), median change from baseline was -35.0° in the ventral cohort vs -25.0° in the nonventral cohort (P < .05); median percent improvement was 48.3% and 37.5%, respectively (P = .11). Median change from baseline in Peyronie's Disease Questionnaire and International Index of Erectile Function domain scores and adverse events were similar between cohorts, with the exception of possibly higher hematoma rates in the nonventral group (50% vs 37%; P = .05). No urethral injuries were sustained in either cohort. Data support the use of CCH for the treatment of ventral as well as nonventral penile curvatures in men with PD. Study strengths are the inclusion of a general clinical population of men with PD, the prospective design, and the relatively large series of men with ventral curvature. Limitations include the single-center and observational nature of the study. CCH was safe and effective in the treatment of both ventral and nonventral penile curvatures in men with PD.

STUDY OF SURGICAL OUTCOME OF HYPOSPADIUS CORRECTION BY MODIFIED SNODGRASS (TUBULARISED INCISED PLATE URETHROPLASTY) TECHNIQUE

Background:The incidence of hypospadias is around 1 in 300 male live births. It is the most common congenital abnormality of the urethra. Diagnosis is made on physical examination. There are three characteristic features, including an ectopic ventrally located urethral meatus usually a ventral penile curvature (chordee) and an incomplete dorsal hood prepuce Surgical repair of hypospadias deformity is a challenging and complex issue. However, the technique of Snodgrass and its modifications attend promising functional and cosmetic results. Aims &amp; Objectives: The paper aims at finding the outcomes of correction of distal and mid-shaft hypospadias by modified snodgrass technique and to compare it with the data available for other techniques Patients And Methods: Source- All patients undergoing surgical correction of hypospadias within the study period of 6 months( 15th March 2023 to 15th September 2023) Type Of The Study: prospective observational study Sample size: 15 patients Inclusion criteria: 1) Patients with distal and mid shaft hypospadias 2) all patients giving consent for the surgery Exclusion criteria: 1) Patients with severe chordee 2) Patients with immunocompromised status 3) Patients not willing to stay in hospital for long as this procedure needs careful dressings and hospital care as we are dealing with children 4) Patients who already underwent modified snodgrass technique Result: This study includes 15 boys with hypospadias. On Presentaion Two Patient Had Mid Shaft Hypospadias With Severe Chordee Rest All Patients Had Distal Shaft Hypospadias With Minimal Chordee. Their ages ranged from 3 to 8 years average 5 years The mean follow up was 3 months and complications were observed in only FIVE (33%) patient. Conclusion: From 15th MARCH 2023 to 15th SEPTEMBER 2023 over 6 months this study has emphasized on the clinical outcomes including any urethrocutaneous fistula , hemorrhage,infection,recurrence of chordee or any stricture formation following modified snodgrass technique and only 20% cases developed urethrocutaneous fistula.

Taping alone for persistent ventral curvature after urethral plate transection in hypospadias

Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy and long-term effects of the procedures used to address curvature. This study aimed to evaluate the effects of urethral plate transection alone with tissue traction therapy on penile curvature in two-stage repair of proximal hypospadias. This was a prospective study of primary hypospadias patients who underwent a two-stage repair with urethral plate transection as the sole straightening procedure. After stage 1, taping was applied as tissue traction therapy and continued until stage 2. Penile curvature was measured using a goniometer under artificial erection before and immediately after urethral plate transection and during the second stage of repair. The primary focus of this investigation is the angle of curvature after 6-month taping. The study included 46 patients with a median age of 13 months at the start of treatment. The median angle of penile ventral curvature was 70° after degloving, 60° after urethral plate transection, and 0° during the second stage of repair. Full correction of ventral curvature was achieved in 42 patients (91%). This publication is the first of its kind to propose taping as a method for penile traction therapy in hypospadias. The study reveals that penile ventral lengthening can be achieved through tissue traction therapy following UP transection alone. These findings challenge the current consensus that complete straightening of the penis in the first stage is necessary to prevent recurrent curvature and that ventral lengthening is required to correct corporal disproportion. However, further validation and long-term data are needed to definitively confirm the effectiveness of tissue traction therapy after urethral plate transection. This study demonstrated significant resolution rate of penile ventral curvature in proximal hypospadias following urethral plate transection alone with taping. Long-term follow-up studies are needed to confirm the sustainability of the results through puberty.

Perioperative Techniques and Long-term Outcomes in Hypospadias: A Systematic Review

Introduction: Hypospadias is a condition when the urethra distal opens on the bottom of the penis and has a ventral penile curvature. Hypospadias is the second most frequent genital birth abnormality in boys after cryptorchidism. Surgery is the standard treatment of choice and has a significant risk problem. There are many surgical procedure complications, especially in appearance and function. This article discusses the appropriate operative management and the best long-term outcome. Methods: The data was culled and selected from the ten years of full-text English publication (2012-2022) utilizing the PubMed and Google Scholar databases. Meta-analyses (PRISMA) paradigm and PICO investigation of management techniques and long-term outcomes in clinical and randomized clinical trials. Result: From 149 search articles, 7 met the inclusion criteria. The gland penis size and the meatal location did not affect the outcome of the surgical technique. However, 58/432 patients required reoperation, and 61(13%) had urethroplasty complications (UC), although not statistically significant (OR 0.8, 95% CI: 0.7-0.9). Testosterone is advised for small penises, narrow glands, thin urethral plates, and proximal hypospadias (67 vs. 87%). Preoperative antibiotics reduce the incidence of infection (17/150 repairs), tubularized incised plate (TIP), and the stent is recommended. Conclusion: The recommended strategies are good perioperative treatment, including antibiotics, testosterone treatment, surgery ages (6-18 months), tubularized incised plate (TIP) technique, and stent postoperative.

Outcome analysis of staged preputial graft technique for primary proximal hypospadias with and without post-operative vacuum physiotherapy

Management of proximal hypospadias remains challenging. We assessed the results of staged preputial graft repairs (SPG) for proximal hypospadias and hypothesize that post-operative vacuum physiotherapy (VP) improves graft suppleness and overall outcomes. Retrospective analysis of n=71 patients with proximal hypospadias and severe ventral penile curvature (PC) of ≥50° after degloving. PC was corrected using ventral transverse incisions of the tunica albuginea (VTITA) without applying a tourniquet, taking care to avoid injuring the underlying erectile tissue. The ventral raw area at the penile shaft, including VTITA, were covered with either divided and partially mobilized urethral plate, or with the inner preputial graft itself. During the second stage, a tunica vaginalis flap was often used to cover the tubularized neourethra. Outcomes and post-op complications were assessed after each stage, comparing patients who received vacuum physiotherapy (VP+, n=49) with those who did not (VP-, n=22). Mean PC was 66°, average follow-up duration was 13.01 months, and overall complication rate was 22.5%. Only 6 of 49 VP+patients experienced complications (12.24%; 4 fistulas; 2 urethral strictures) and no recurrence of PC after second stage was observed in this group. VP- patients displayed a significantly higher rate of complications, with 10 of 22 cases (45.45%) exhibiting fistula development (n=5) and glans dehiscence (n=5). Recurrence of mild PC after first-stage repair was comparable between patient groups (12% VP+, 18% VP-) and easily corrected by simple graft tubularization or dorsal plication during second-stage repair. Staged repair using VTITA is effective for correcting proximal hypospadias with severe chordee. VP appears to promote and expedite graft suppleness and significantly improves patient outcomes.

Expanded Utilization of Intralesional Therapies for Treatment of Peyronie's Disease.

In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade. Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time. Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.

(405) Penile Prosthesis Implantation and Peyronie's Disease: How to Approach the Residual Curvature – A Detailed Demonstration of Moulding Technique and Grafting Procedure

Abstract Introduction Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing. Objective This video highlights strategies that will aid the implanter when faced with these intraoperative challenges. Methods This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (&amp;gt;30 degrees) following moulding. A fibrin sealant patch was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation. Results All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery. Conclusions Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including fibrin sealant patch or bovine pericardium. Disclosure No

(161) Xiaflex Nonresponders Show Alteration in Penile Measurements: Post-Market Analysis of Predictors for Treatment Success

Abstract Introduction The IMPRESS trial revealed that intralesional collagenase clostridium histolyticum, Xiaflex, is safe and efficacious for treating the physical and subjective effects of Peyronie’s Disease (PD). However, little is known about the other manifestations of PD, namely penile shortening and efficacy for patients of diverse racial backgrounds or with severe penile curvatures. Objective To evaluate predictors associated with response to treatment and alterations in penile morphological measurements. Methods Consecutive patients treated with Xiaflex for dorsal, lateral, and ventral penile curvatures ≥ 25°, in the absence of hourglass deformity, were included in this study. Before treatment and eight weeks after the last injection cycle, during penile duplex Doppler ultrasound evaluation, penile curvature was measured with a goniometer after induced artificial erection via injection of prostaglandin E1 (PGE1). IIEF score, PGE1 dose, circumference, and erectile as well as stretched penile length were also assessed at these times. Based on the results of the IMPRESS trial, patients were considered Xiaflex responders if the decrease in their penile curvature were ≥ 15° (n =134) and Xiaflex nonresponders if the decrease in their penile curvature were &amp;lt; 15° (n =89). Initial measurements were in increments of 5°. Intention to treat analysis was performed. Results Two hundred and twenty-three patients with penile curvature ≥ 25° who received XIAFLEX were included in this study. One hundred and thirty-four patients (60.1%) responded to Xiaflex, while 89 (39.9%) patients did not respond. African American men were 3 times more likely to respond to treatment than their non-African American counterparts (Odds Ratio (OR) =3.35 (95% CI, 1.15-10.70), p =0.031). On the other hand, men with an initial penile curvature of greater than 60° were less likely to respond to Xiaflex (OR = 0.34; 95% CI, 0.16-0.69; p=0.003). However, patients with lateral and ventral curvatures responded at comparable rates to those with dorsal curvatures. Subsequently, changes in penile morphologic measurements post Xiaflex were analyzed. Average stretched penile length, erectile length, and erectile circumference prior to treatment for responders were 13.93 cm, 13.39 cm, and 11.81 cm, respectively; for nonresponders, it was 14.27 cm, 13.72 cm, 11.64 cm, respectively. Nonresponders were shown to experience a significant decrease in penile erect length (-0.55 cm) and circumference (-0.58 cm) (p=0.002 and p=0.002, respectively), whereas responders showed no significant alterations in penile morphologic measurements. Conclusions Our analysis revealed that men with penile curvatures ≥ 60° are less likely to respond to Xiaflex injections and thus may be considered for surgical intervention upon initial presentation. Furthermore, men who do not respond may even be at a higher risk for shortening of penile erect length and circumference. The actual clinical significance of a decrease in average erect length of 0.55 cm and circumference of 0.58 cm is difficult to determine and should be considered per patient preferences. Further investigations into predictors for response to Xiaflex and the pathophysiology behind penile shortening in Xiaflex nonresponders are warranted. Disclosure No

V11-01 DEEP DORSAL VEIN BED PLICATION FOR VENTRAL PENILE CURVATURE

You have accessJournal of UrologyCME1 Apr 2023V11-01 DEEP DORSAL VEIN BED PLICATION FOR VENTRAL PENILE CURVATURE Pedro Caetano Edler Zandoná, Guilherme Garcia Barros, Igor Valente Coimbra, Plinio Moreira De Góes, Eduardo Zinoni Silva Pato, William Carlos Nahas, Bruno Chiesa Gouveia Nascimento, and Jorge Hallak Pedro Caetano Edler ZandonáPedro Caetano Edler Zandoná More articles by this author , Guilherme Garcia BarrosGuilherme Garcia Barros More articles by this author , Igor Valente CoimbraIgor Valente Coimbra More articles by this author , Plinio Moreira De GóesPlinio Moreira De Góes More articles by this author , Eduardo Zinoni Silva PatoEduardo Zinoni Silva Pato More articles by this author , William Carlos NahasWilliam Carlos Nahas More articles by this author , Bruno Chiesa Gouveia NascimentoBruno Chiesa Gouveia Nascimento More articles by this author , and Jorge HallakJorge Hallak More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Either Congenital Penile Curvature or Peyronie’s Disease may cause severe ventral curvature. Historically, surgical techniques for this type of deformities were associated with longer operative time and greater patient dissatisfaction, mainly due to neurovascular bundle (NVB) dissection [1]. Previous studies described a midline dorsal plication technique in pediatric patients, allowing for an effective correction without requiring NVB manipulation [2-5]. Neuroanatomical studies have demonstrated the distribution of nerve fibers and identified the 12 o'clock position as the only nerve-free position [2]. Finally, in 2021, Bagnara et al published the description of the Giammusso corporoplasty in adults [6]. We aim to demonstrate with this video article the step by step of this previously published technique for ventral penile curvature correction. METHODS: This video article is a compilation of images of three surgeries performed for ventral penile curvature utilizing an adaptation of the Giammusso Corporoplasty technique. In the main video, the procedure was performed for a 26-year old male with a 62-degree ventral congenital penile curvature. Supplementary photographs of other two cases were added to the video: a 77-year old male with a 68-degree Peyronie’s ventral curvature and a 29-year old male with a 28-degree ventral congenital penile curvature. In all cases, a subcoronal incision was performed, and penile skin and Dartos’ fascia were degloved. The point of maximum curvature was identified after a saline induced artificial erection, Buck’s fascia was incised, and deep dorsal vein and its branches were then dissected and ligated. Differently from the Giammusso technique, we did not perform a corporoplasty, but a simple plication as described by Akdemir et al [5]. This latter technique however spares the deep dorsal vein. For the plication, after planning and marking their sites with Allys clamp and artificial erection confirming functional alignment, we utilized 3 inverted non-absorbable 2-0 coated polyester sutures for each plication site. Circumcision was performed for penile shaft closure. RESULTS: The three patients shown in this video obtained functional penile alignment, and no change in glans sensation. No severe adverse event was observed, with one patient developing a small penile hematoma managed conservatively. CONCLUSIONS: This video article describes Deep Dorsal Vein Bed Plication, a feasible and effective technique for ventral penile curvature treatment, which avoids NVB dissection and its associated risks such as glans hypoesthesia and glans necrosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e999 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pedro Caetano Edler Zandoná More articles by this author Guilherme Garcia Barros More articles by this author Igor Valente Coimbra More articles by this author Plinio Moreira De Góes More articles by this author Eduardo Zinoni Silva Pato More articles by this author William Carlos Nahas More articles by this author Bruno Chiesa Gouveia Nascimento More articles by this author Jorge Hallak More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-04 REPAIR OF URINARY INCONTINENCE AND VENTRAL DEHISCENCE AFTER MASCULINIZING GENITAL GENDER AFFIRMATION SURGERY

You have accessJournal of UrologyCME1 Apr 2023V09-04 REPAIR OF URINARY INCONTINENCE AND VENTRAL DEHISCENCE AFTER MASCULINIZING GENITAL GENDER AFFIRMATION SURGERY Joshua Sterling and Dmitriy Nikolavsky Joshua SterlingJoshua Sterling More articles by this author and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is an infrequently reported complication following transmasculine genital gender affirming surgery (gGAS), thus far there are no reports to help with management of severe SUI post gGAS. In this video, we demonstrate a case of de novo SUI following vaginectomy and metoidioplasty. These were treated with autologous fascial sling and staged urethral repair. METHODS: Patient is a 22 year old transgender male who underwent vaginectomy and metoidioplasty and developed severe SUI. Three months of pelvic therapy improved incontinence to 168g daily. He was referred for treatment of SUI and correction of ventral shaft dehiscence. Stage-1 included placement of an autologous fascial retropubic sling, and stage 1 urethroplasty with buccal mucosa graft (BMG). In the time interval before the Stage 2, the patient was monitored for evidence of recurrent SUI or urinary retention. Stage 2 involved tubularization of the neourethra. The procedure was done in dorsal lithotomy position. Perineum (site of prior vaginectomy) and previously created pars fixa were opened ventrally. Using the balloon of the Foley at the bladder neck as a palpable landmark, the native urethra and the bladder neck were dissected to the inferior aspect of the pubic symphysis. A 1.5x8cm segment of rectus fascia was harvested for the autologous sling. Full length 2-0 polypropylene suture was secured to either end of the fascial sling and delivered retropubicly to the abdominal incision from the perineal incision using a fine tonsil clamp. The sling was appropriately tensioned and secured. Ventral penile chordee was released sharply and a stage 1 urethroplasty was performed with dorsal BMG inlay. After a 6-month delay the patient did not show any signs of recurrence of SUI or retention and the Stage 2 urethroplasty was performed. The patient's urethral plate was augmented with an additional BMG to achieve 3cm width. The neourethra was tubularized and the neophallus was closed in multiple layers with non-overlapping suture lines. RESULTS: The procedure resulted in the successful repair of the patient’s SUI and metoidioplasty shaft dehiscence. The patient achieved durable social continence (completely dry) with normal voiding patterns and low residuals after placement of autologous retropubic sling. CONCLUSIONS: SUI is a real and devastating complication following masculinizing gGAS. Here we show it can be safely and effectively treated using an established pelvic floor reconstructive technique for a new indication. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e837 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Congenital anterior urethral diverticulum in children: case series and review of the literature

BackgroundCongenital anterior urethral diverticulum (CAUD) is a rare condition in children. This condition can present at any age; however, it is more commonly identified in infants and older children. The patient may present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. Children with large anterior urethral diverticulum with poor spongiosal support may also complain of cystic ventral penile swelling during micturition.MethodsIn this series, we report seven such cases of congenital anterior urethral diverticulum treated over a period of 12 years (2008–2020). All cases presented to the Pediatric Surgery Department with dysuria, dribbling of urine, recurrent urinary tract infection, and/or fluctuant ventral penile swelling. They were further evaluated with retrograde urethrography with micturating cysto-urethrogram and cysto-urethroscopy.ResultsThree cases had anterior urethral valves that were managed by cystoscopic fulguration of valves. Surprisingly, all these three cases had concomitant posterior urethral valves, while the other four cases presented with relatively larger and saccular anterior urethral diverticulum required excision of the diverticulum and primary urethral reconstruction.ConclusionsThe cases with congenital anterior urethral diverticulum secondary to anterior urethral valves may also be associated with posterior urethral valves as seen in our case series. Surgeons should be aware of this association, and both valves should be fulgurated in the same sitting. A larger and saccular anterior urethral diverticulum requires excision and urethroplasty as a definitive procedure.

Anatomic maps of erogenous sensation and pleasure in the penis: are there difference between circumcised and uncircumcised men?

The effects of male circumcision on sexual function remain controversial. Heterogeneity across previous studies and low-quality scientific evidence have resulted in poor understanding of the effects of circumcision on erogenous sensation of the penis and orgasm function. In this study we sought to describe and assess differences in erogenous genital sensation and reported orgasm function in circumcised compared with uncircumcised men. Adult male subjects who were recruited on a paid anonymous online survey platform were shown illustrations of 12 anatomic regions of the penis. Subjects were prompted to designate regions as pleasurable when touched during partnered sex and to rate each on a 1-10 scale, with higher erogeneity scores correlating with greater pleasure. Subjects were also asked to characterize their orgasms across 6 experiential domains. Outcomes were differences between circumcised and uncircumcised men in the probabilities that regions would be designated as pleasurable, average pleasure scores, and self-reported orgasm parameters. In total, 227 circumcised (mean [SD] age 46.6 [17.7] years) and 175 uncircumcised men (47.8 [18.1] years) completed the survey. There were no significant differences in average ratings across all regions between circumcised and uncircumcised men. However, significantly more circumcised men reported preferences for the tip of the penis (38% vs 17%, P = .02) and the middle third of the ventral penile shaft (63% vs 48%, P = .04). Additionally, there were no significant differences in orgasm quality and function across all queried domains between circumcised and uncircumcised cohorts. Our findings suggest that circumcision does not change how men describe erogenous genital sensation or how they experience orgasm. In this study we expanded upon existing literature regarding comparison of sexual function in circumcised and uncircumcised men in its scale and investigation of diverse domains. Limitations include the survey format of data collection. We found no differences in reported erogenous ratings or orgasm function between circumcised and uncircumcised men. These findings suggest that male circumcision does not negatively impact penile erogeneity or orgasm function.

Fasciocutaneous foreskin twin flaps in hypospadias repair: Reconstructing a functional penis with freestyle design

Hypospadias is the most common congenital urological deformity in males; however, there is still no perfect solution or surgical method for one-stage operations to fix proximal hypospadias with ventral penile curvature (VPC). We developed a fasciocutaneous foreskin twin flap technique that can provide freestyle flap designs in hypospadias repair. A retrospective study including 26 patients was performed between January 2017 and June 2020. The surgical procedures included VPC correction, skin flap design, transfer and reconstruction. The urethra and shaft were reconstructed by twin flaps in one stage. All patients were followed up until 12 months. All VPC cases were corrected after the operation. The fistula rate was 11.5% (3/26). No meatal stenosis, urethral diverticulum, or stricture was observed. A total of 92.3% (24/26) of patients were satisfied with their penis appearance. The fasciocutaneous foreskin twin flaps provide freestyle designs in hypospadias repair, which can achieve a one-stage operation for proximal hypospadias with low fistula rates.