Corporeal penile plication for correction of erectile penile deformity.

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3-48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.     

Ten years outcome analysis of corporeal plication for Peyronie’s Disease

Objective To evaluate the long-term results of plication of tunica albuginea in patients with penile curvature secondary to Peyronie’s disease. Patients and methods A total of 78 men with penile curvature secondary to Peyronie’s disease underwent corporeal plication over a 10 year period. To assess the long-term results, a questionnaire-based study was undertaken on 73 of these patients with a time lapse of > 6 months after the operation. The questionnaire focussed on the presence or absence of penile deformity and pain, erectile function and the ability to perform sexual intercourse. Results Follow up ranged from 3 to 109 months with a median of 51 months. The cosmetic result was good or excellent (straight or almost straight penis) in 94% by 6 months. A total of 57 replies to the questionnaire were suitable for analysis. A total of 90% patients had a satisfactory cosmetic result, whereas only 71% reported a satisfactory functional result (straight or almost straight penis on erection with pain free penetration and normal sexual intercourse) in the long-term. In patients with > 3 years follow up, the cosmetic and functional success rates were 83% and 67%, respectively, and for patients with > 5 years follow up the corresponding figures were 82% and 71%, respectively. The main causes of functional failure were pain, erectile dysfunction and persisting deformity. There were no major complications associated with the procedure. Conclusions Corporeal plication is an effective surgical option for the correction of penile deformity in patients with Peyronie’s disease, with good cosmetic results and acceptable functional success rate in the long-term.     

Congenital penile curvature： long-term results of operative treatment using the plication procedure

Aim: To determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea. Methods: From January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients. Results: Penile straightening was excellent in 62 patients (91%) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-Five patients (51%) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied. Conclusion: Corporeal plication is an effective and durable procedure with a high rate of patient satisfaction. (Asian J Androl 2004 Sep; 6: 273-276)     

The Nesbit operation for penile curvature: an easy and effective technical modification

PURPOSE: We report the results of an original technical modification to the Nesbit operation, designed to increase precision and simplify the correction of congenital or acquired penile curvature. MATERIALS AND METHODS: A total of 50 patients were considered candidates for surgical treatment of penile curvature and underwent a modified corporoplasty procedure involving plication suture on the convex aspect of the penis before tunica albuginea resection. Hospital records and followup data were retrospectively reviewed. RESULTS: A total of 32 patients had congenital penile curvature with a mean angle of 48 degrees (range 40 to 90) and difficult vaginal penetration. Another 18 patients had Peyronie's disease with penile deformity with a mean angle of 48 degrees (range 40 to 60) without hourglass deformity or hinge effects. All patients had spontaneous and full erections. Mean operative time +/- SD was 62 +/- 15 minutes. No intraoperative complications were recorded. In all cases penile curvature was completely corrected. Neither residual curvature nor hypercorrection were recorded. Regarding erectile function, which was evaluated in the Peyronie's disease group, preoperative average International Index of Erectile Function-5 score was 17.83 +/- 4.17, whereas postoperatively it was 19 +/- 4.63 (p = 0.036). Regarding overall satisfaction, 3 patients (6%) with Peyronie's disease were unsatisfied. CONCLUSIONS: Our modified corporoplasty procedure results in an improved straightening outcome due to the possibility of performing tunica albuginea excision only after the surgeon has made and verified the exact correction in real time. A slight but statistically significant improvement in erectile function was observed in patients with Peyronie's disease.     

Innovative surgical techniques for managing Peyronie’s disease: a video presentation

Peyronie’s disease is a disorder caused by fibrosis of the tunica albuginea, which results in penile deformity, pain, and can be associated with erectile dysfunction. Treatment options include a variety of medical and surgical approaches, with no clear consensus as to the best treatment option. Many medical therapies have been investigated, including oral, topical, injectable, and external-energy agents. Surgical management can involve plication with or without plaque resection, grafting procedures, or, in extreme cases, penile prosthesis implantation. Two of these treatment techniques are presented in a detailed technical review: the 16-dot plication and tunica-sparing plaque excision.     

阴茎折断的临床分析

目的分析阴茎折断的临床特点和治疗经验。方法回顾性分析我院2003年10月至2016年6月收治的19例阴茎折断患者的临床资料,并复习近年相关文献。19例患者致伤原因为性交失误17例,粗暴性交2例。除1例保守治疗外,均急诊行阴茎血肿清除、白膜修补术。结果术后随访6~12个月,1例术后短期自感勃起时硬度较前有所下降,其余未发生阴茎畸形、勃起疼痛、勃起功能障碍等并发症。结论病史及查体是确诊阴茎折断的重要依据,尽早手术是阴茎折断的恰当治疗方法。     

SURGEON EXPERIENCE WITH PENILE FRACTURE

PURPOSE: The experience of a single surgeon with a series of 34 penile fractures, including 29 corrected surgically and 5 managed conservatively, at 3 large inner city medical centers in an 11-year period is presented. Standard diagnostic and therapeutic modalities are described that have evolved with time. MATERIALS AND METHODS: Between 1989 and 1999, 34 patients 18 to 38 years old (mean age 27 at presentation) were evaluated after blunt trauma to the erect penis. The interval from injury to presentation was between 6 and 72 hours. Of these patients 32 and 2 had been injured during sexual intercourse and masturbation, respectively. Surgery in 29 cases involved a degloving incision, and intraoperative evaluation of the corpora and urethra by radiography or saline injection. Five patients were treated conservatively for presumed penile fracture after they refused diagnostic confirmation and/or surgery. RESULTS: Injury involved unilateral and bilateral corporeal rupture in 25 and 3 cases, respectively, and urethral injury in 5. Urinalysis in 6 patients demonstrated microscopic hematuria with 5 to 10 red blood cells, although there were several false-negative urethrograms and cavernosograms. At followup 33 of the 34 patients available reported erection adequate for intercourse without erectile or voiding dysfunction, while 2 reported mild to moderate curvature. CONCLUSIONS: A degloving procedure with a urethral catheter in place provides the best exposure and orientation. In addition, saline injection may demonstrate additional corporeal body and/or urethral pathology as well as assess the integrity of repair. Although surgical repair was not associated with serious sequelae, a small subgroup of patients with presumed penile fracture also had no sequelae.     

Modified plication of the tunica albuginea in treating congenital penile curvature

OBJECTIVE: To describe a modified plication technique and compare the results with the Nesbit procedure for treating congenital penile curvature. PATIENTS AND METHODS: Eleven men with congenital penile curvature were treated by a modified tunica albuginea plication technique. An artificial erection was induced by normal saline injection; in the areas where plication was planned, Buck's fascia was opened longitudinally and dissected a short distance toward the midline to free the neurovascular bundles. Allis clamps were used to grasp the tunica albuginea and "bumps" created. Two interrupted U-shaped sutures using 2/0 polyglactin were placed underneath each Allis clamp to secure the bump. The results were analysed retrospectively and compared with the results of 11 other men treated using the Nesbit procedure. RESULTS: The mean (range) follow-up was 25 (12-47) months for the Nesbit procedure and 15 (8-26) months for the modified plication procedure. In the Nesbit group, eight patients had satisfactory cosmetic and functional results; three complained of penile shortening and one had erectile dysfunction. In the modified plication group, 10 patients reported satisfactory cosmetic and functional results; one complained of penile shortening, two were concerned about the indurations of the penis but none had erectile dysfunction. CONCLUSIONS: The modified plication technique is easier to perform, is more often successful and causes fewer surgical complications than the Nesbit procedure for treating congenital penile curvature.     

Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results

PURPOSE: A Nesbit or plication procedure for correcting penile deformities is associated with penile shortening, especially in patients with excessive curvature and/or rotation. On the other hand, grafting procedures are associated with poor postoperative results due to graft shrinkage and veno-occlusive dysfunction. To minimize penile shortening and preserve potency we describe a new surgical technique combining the Nesbit procedure with tunica albuginea free grafting. Long-term functional results and patient satisfaction are reported. MATERIALS AND METHODS: We treated 17 potent patients with a mean age plus or minus standard deviation of 46.1 +/- 14.5 years, including 4 with congenital penile deviation and 13 with stabilized Peyronie's disease. Opposite the point of maximal curvature a typical Nesbit procedure was performed. The excised tunica albuginea segment consequently served as a free graft. A symmetrical incision was made at the opposite site and the preserved elliptical tunica albuginea graft was placed in the defect. Further elliptical excisions and grafting followed as needed to correct the deformity. RESULTS: At a mean followup of 39.5 +/- 13.7 months (range 18 to 62) all patients reported penile straightening and functional erection, while ultrasonography of the corpora cavernosa revealed no changes in graft ultrastructure. There was penile shortening in 8 patients (47%) but only 2 (11.7%) considered it significant. All patients with a minimum 2-year followup were positive in regard to recommending the operation to others or repeating it if necessary. CONCLUSIONS: The newly described technique may be considered as a treatment option in patients with excessive penile curvature since shortening of the penile shaft is eliminated by 50% compared with the result of the Nesbit procedure. Tunica albuginea seems to be an appropriate grafting material since it prevents postoperative corporeal veno-occlusive dysfunction.     

阴茎弯曲的治疗(附20例报告)

目的:提高对阴茎弯曲的诊断及外科治疗水平。方法:回顾性分析20例阴茎弯曲矫形术及术后并发症,其中15例为先天性阴茎弯曲类型,采用阴茎皮肤袖状脱套+可吸收缝线单纯阴茎白膜折叠术矫形弯曲;5例为继发性阴茎弯曲患者,采用斑块切除+膀胱黏膜补片矫正阴茎弯曲。结果:20例术后随访6～24个月,平均18个月,无血肿,感染,尿瘘,阴茎感觉改变,勃起疼痛及勃起功能障碍等并发症,术后矫正率90%,2例术后矫正阴茎稍弯曲<15°,1例术后阴茎缩短约2cm。结论:根据阴茎弯曲的程度,选择合理的手术方式,可矫正阴茎弯曲,保证有效的勃起功能及一定的阴茎长度。     

Correction of penile deformity assisted by intracavernous injection of papaverine.

Sexual dysfunction resulting from penile deformity is amenable to surgical correction. We describe a simplified technique in which surgical plication with nonabsorbable sutures is assisted by intraoperative erection induced by intracavernous papaverine. This procedure can be performed in an ambulatory surgery center with the patient under local anesthesia with minimal postoperative morbidity. To date we have treated 6 patients and followup ranges from 12 to 24 months. All patients have straight erections and retain normal erectile function.     

阴茎海绵体摺叠术纠正阴茎弯曲畸形

自１９８９年１２月至１９９３年３月对１５例阴茎弯曲患者施行弯曲纠正手术作回顾性分析，随访期３个月至３年，平均１６个月。全部病例接受阴茎海绵体摺叠术，即在弯曲的凸面进行缝合以拉直阴茎。３例（２０％）在手术后３个月至１年内复发，需再次手术。１３例（８６．６％）对手术效果满意，阴茎挺直，性交时无疼痛或不适。１例（６７％）出现静脉渗漏性阳萎，施行了阴茎深静脉结扎剥脱术。     

Surgical treatment of Peyronie's disease: a critical analysis

OBJECTIVE: The present paper reviews surgical treatment alternatives for patients with Peyronie's disease using knowledge obtained from the contemporary literature. METHODS: : All aspects of surgical treatment for Peyronie's disease were examined on the basis of MEDLINE database researches. RESULTS: Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. PD patients with good erectile capacity are candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered for patients without adequate erectile capacity. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity.     

Corporeal plication for the treatment of congenital penile curvature

PURPOSE: We evaluated the long-term outcome, effectiveness and patient satisfaction of corporeal plication for the correction of congenital penile curvature. MATERIALS AND METHODS: A total of 25 patients with congenital penile curvature were included in the study. Mean age was 39 years (range 15 to 45). Patients with Peyronie's disease, and/or chordee associated with hypospadias or evidence of erectile dysfunction were excluded from analysis. All procedures were done on an outpatient basis using local anesthesia. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the opposing side of curvature until it is corrected during artificially induced erection. A standardized questionnaire was then completed via telephone interview to assess results as well as the patient satisfaction rate. RESULTS: A total of 22 patients were available for evaluation. Successful results at up to 3(1/2) years (range 1 to 42 months, mean 18) of followup were achieved in 21 of the 22 patients (95%). Success was defined as the correction of curvature and a patient satisfaction rate of 75% or greater. Curvature was ventral in 20 cases, dorsal in 2 and left lateral in 3. Shortening of the penis after surgery was noted by 4 patients (18%), of whom 3 nevertheless had a satisfaction rate of 75% or greater. In 2 patients postoperative hematoma resolved spontaneously. Mean operative time was 50 minutes and 22 of the 25 patients (88%) received local anesthesia. CONCLUSIONS: Corporeal plication is a simple, minimally invasive surgical procedure that proved to be effective for congenital curvature of the penis compared with other, more extensive penile reconstruction surgery.     

A retrospective review of 307 men with Peyronie's disease

PURPOSE: We discuss the clinical appearance and natural outcome of Peyronie's disease. MATERIALS AND METHODS: During an 8-year period 307 men with Peyronie's disease were evaluated, and clinical characteristics, risk (factors), penile deformities, erectile status and outcome were analyzed. RESULTS: Mean patient age plus or minus standard deviation was 52.8 +/- 9.3 years (range 23 to 76). Penile deformity, pain on erection and palpable nodule were the most common (85%) presenting symptoms, usually in different combinations. The remaining 15% of men (mean age 59.4 +/- 6.5 years) were not aware of the penile deformity and were diagnosed during standard evaluation for erectile dysfunction. Dorsal (45.6%) and lateral (29.3%) were the most common curvatures. The degree of deformity was less than 30 degrees in 42.7% of patients, 31 to 60 degrees in 38.8% and greater than 60 degrees in 18.6%. At least 1 risk factor for systemic vascular disease was identified in 67.5% of patients, and hypercholesterolemia and diabetes were the most common. Patients with at least 1 risk factor had a significantly higher risk for severe penile deformity. Of the men 54.4% complained of erectile dysfunction and the probability of diminished erectile capacity was 86.7% in patients older than 60 years, with Peyronie's disease for more than 12 months and at least 1 risk factor. Of 63 patients presenting with the acute phase of disease penile deformity deteriorated in 30.2%, did not change in 66.7% and resolved spontaneously in 3.2% without any treatment after a mean followup of 8.4 months. CONCLUSIONS: Our data show that penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as serum lipid abnormalities, diabetes and hypertension, seem to have significant impact on the severity of symptoms and outcome. Patients must be informed that Peyronie's disease is progressive in 30.2% without treatment and spontaneous resolution is rare.     

阴茎再造新术式探讨

目的:探讨再造阴茎的新方法.方法:应用肩胛游离皮瓣移植和银丝棒硅胶阴茎假体置入行一期阴茎再造术.其中3例保留残存阴茎体,待后期形成含有阴茎背神经血管束的岛状龟头瓣移植于再造阴茎体体表合适位置的患者,列为保留残存阴茎体组,其余病例做为对照组.结果:再造阴茎术后6例皮瓣全部成活.经随访6～12个月,再造阴茎形态良好,供区无明显继发畸形.保留残存阴茎体组再造阴茎的感觉和勃起功能较对照组更为满意.结论:该术式是一种全新的再造阴茎的新方法.保留残存阴茎体,后期可移植含有阴茎背神经血管束的岛状龟头瓣,有助于再造阴茎感觉功能的恢复和勃起功能的完成     

Correction of penile curvature using the 16-dot plication technique: a review of 132 patients

PURPOSE: We review the results of 132 cases of congenital and acquired penile curvature corrected with our 16 or 24-dot, minimal tension technique using multiple parallel plications performed under papaverine induced erection. MATERIALS AND METHODS: Chart and telephone interviews were conducted on 132 consecutive patients 16 to 79 years old who underwent penile plication between December 1995 and November 2000. Patient data as well as outcomes were analyzed. RESULTS: We were unable to contact 8 patients. Of the patients 16 had congenital penile curvature, including 4 in whom the Nesbit procedure performed elsewhere had failed, and 116 had Peyronie's disease, including 8 in whom a previous Nesbit procedure had failed. Preoperative complaints included persistent penile pain with erection for more than 1 year in 15 of 132 cases, difficult intercourse or partner discomfort in 106 and poor self-image in 11. Curvature ranged from 30 to 120 degrees. Erections were evaluated preoperatively with duplex ultrasound after intracavernous injection and self-stimulation. Of the patients 63% had good erections, 25% moderate erections requiring sildenafil and 12% poor erections requiring injection therapy. Foreskin edema necessitating subsequent circumcision and an organized hematoma requiring evacuation occurred in 1 case each. At 6 months 93% of patients reported straight erections and 7% reported almost straight but acceptable erections. Recurrence of curvature was reported by 15% of patients at a mean of 2.6 years of followup. Four patients reported worsening of erectile function after the procedure. CONCLUSIONS: Penile plication is a simple, safe method to correct congenital and acquired penile curvature. Using a minimal tension parallel plication technique, excellent durable results can be attained. This simplified repair avoids the neurovascular bundles and has a minimal to no detrimental affect on erectile function. Preoperative counseling must be given regarding penile shortening and the palpable small bumps from the nonabsorbable sutures.     

Surgery for Peyronie's disease

Peyronie''s disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.     

Complications of porcine small intestine submucosa graft for Peyronie's disease

PURPOSE: We report outcomes and complications of the use of porcine small intestine submucosa for correcting penile curvature due to Peyronie's disease. MATERIALS AND METHODS: A retrospective study was performed in patients with severe penile curvature (greater than 60 degrees) requiring surgical correction for sexual function. Preoperatively all patients underwent evaluation, including history, physical and penile duplex ultrasound. Of these patients 19 underwent tunical grafting with 1-layer Surgisis small intestine submucosa. Postoperatively patients were evaluated with clinic visits and telephone interviews to assess results. RESULTS: A total of 19 patients 46 to 69 years old (mean age 54) were treated with tunical incision or excision and grafting with small intestine submucosa between March 2002 and July 2005. Average followup was 15 months (range 3 to 43). Patients reported less penile pain with intercourse after surgery. There was no difference in Sexual Health Inventory for Men scores. Preoperatively 12 men (63%) had erectile dysfunction, defined as Sexual Health Inventory for Men less than 21, while 10 (53%) reported postoperative erectile dysfunction. Seven of the 19 patients (37%) had recurrent penile curvature (greater than 10 degrees) and 5 (26%) had recurrent Peyronie's disease plaque. Our complication rate was 37%, including hematoma at the graft site in 5 cases (26%), graft infection in 1 (5%) and Peyronie's disease recurrence requiring plication in 1 (5%). CONCLUSIONS: Small intestine submucosa carries potential for grafting applications because it is easy to use and readily available. Our experience resulted in a 37% complication rate, which exceeds those previously reported with saphenous vein graft repair.