Horizontal plication after vertical tunical incisions for the correction of congenital penile curvature

The objective of this retrospective study is to evaluate the surgical outcome of correction of congenital penile curvature, via multiple vertical incisions in the tunica albuginea that are sutured horizontally using simple inverted 2-0 PDS sutures. The study included 22 men with congenital penile curvature. The surgeries were performed in three general hospitals. The procedures straightened the penile shaft in all cases but a degree of curvature recurred in three cases. No operative or postoperative complications occurred and no reoperations were needed. Four patients complained of penile shortening. We conclude that horizontal plication after vertical corporal incisions is safe and effective in the treatment for congenital penile curvature without hypospadius.     

Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures.

OBJECTIVE: To compare the cosmetic outcome, pain and tenderness around the operation scar of carpal tunnel syndrome surgery using either nylon, polyglactin 910 or stainless steel sutures for skin closure. METHODS: A randomised clinical trial comparing nylon, polyglactin 910 or stainless steel sutures for skin closure in 61 patients undergoing carpal tunnel syndrome surgery was performed. Pain, tenderness, scar hypertrophy, redness and the presence of granulomas were assessed in all patients at ten days and six weeks after surgery and compared by non-parametric statistical tests. RESULTS: Adequate surgical decompression of the median nerve could be achieved in all patients. All but two patients experienced significant relief of tingling of the fingers. Nearly all patients reported some degree of discomfort around the scar. At ten days, the mean pain score was 1.7 (+/-2.2), 3.1 (+/-2.3) and 1.9 (+/-2.3) for the nylon, vicryl and steel groups, respectively. At six weeks, the pain score was 3.6 (+/-3.1), 3.4 (+/-2.6) and 2.7 (+/-2.1) for the nylon, vicryl and steel groups, respectively. The infection rate was 0%, 8% and 0% for the nylon, vicryl and steel groups, respectively. Suture granulomas were significantly more present in the vicryl group (p<0.05). There were no statistical differences in redness or hypertrophy of the wound between the three groups. CONCLUSIONS: Nylon and stainless steel sutures are both suitable for skin closure after carpal tunnel surgery. Based on this study, absorbable vicryl sutures should not be used, since the incidence of infections and the presence of suture granulomas was much higher than in the nylon and steel suture groups.     

Saphenous vein harvesting by 'stripping' technique and 'W'-shaped patch covering after plaque incision in treatment of Peyronie's disease.

Harvesting of the saphenous vein tract by means of leg stripping is proposed in the treatment of Peyronie's disease. The technique of W-shaped saphenous vein after plaque incision to correct severe penile deformity associated with Peyronie's disease is described. Graft material was obtained from the lower saphenous vein by means of distal 'leg short stripping' technique. The size and number of tunical incisions depended on the size of the plaque. A 15 cm venous segment is generally sufficient to cover the defect. The venous segment used was W-shaped, assembled with 6/0 polydioxanone (PDS) uninterrupted sutures and then sutured to the albuginea defect. In our preliminary series of eight patients, penile shortening and erectile dysfunction is absent. Complete correction of penile deformity was achieved in seven patients (87.5%). One patient had minimal residual curvature (<20 degrees ) which did not result in difficulty with intromission. Saphenous harvesting by the stripping technique is not an invasive procedure and is quick and simple to perform. The W-shaped assembling technique is safe because the piece of saphena is kept intact and may be suited properly to the albuginea defect.     

Der Einfluss verschiedener Nahtstärken auf das Verhalten von Meniskusnähten unter zyklischer Zugbelastung

The aim of this study was to analyze meniscal sutures under cyclic loading conditions for different suture types (vertical and horizontal mattress sutures) and suture materials (absorbable monofilament sutures: PDS 2-0; PDS-0, and PDS-1 USP). Testing was performed on medial porcine menisci, using a well-established biomechanical testing model with a complete longitudinal tear 3 mm from the periphery of the meniscus. Sixty specimens were used. One suture was tested at a time. During cyclic testing 100 load cycles were applied with a crosshead speed of 50 mm/min. Three different maximum loads (10 N, 20 N, and 40 N) were used. The preload was set at 5 N. After cyclic loading, the specimens were loaded until failure. During cyclic loading, a gap appeared between the two parts of the meniscus, and partial tissue failures were observed at the surface of the meniscus. Gapping was more marked with higher loads and with the weaker suture material (p < 0.001). Using PDS 0 and PDS 1 sutures, less partial tissue failures were observed compared to PDS 2-0 (p < 0.001). The ultimate failure loads after cyclic loading were higher with PDS-0 and PDS-1 sutures. With these suture materials vertical sutures were stronger than horizontal sutures (p < 0.05). Using PDS 2-0 this difference could not be found. These results show that the primary strength of meniscal sutures depends on the suture material. The frequency and the amount of gapping and partial tissue failures, which can be observed under cyclic loading, are less distinct with PDS-0 and PDS-1 compared to PDS 2-0. From a biomechanical point of view, PDS 0 and PDS 1 sutures are recommended for meniscal sutures to guarantee a high primary stability, a small amount of gapping, and few partial tissue failures.     

Long-term results of Essed-Schroeder plication by the use of non-absorbable Goretex sutures for correcting congenital penile curvature

This study evaluated the long-term outcome of the Essed-Schroeder procedure for correcting congenital penile curvature using non-absorbable Goretex sutures. The Essed-Schroeder procedure was performed in 35 patients with congenital ventral penile curvature (minimum 30 degrees ). Follow-up included a standardized interview with measurement of angulation. Twenty-three of 35 patients were available for complete long-term follow-up (average 34.3 months). The mean preoperative ventral curvature was 54 degrees. In 17/23 patients, the penis remained straightened. Recurrent curvature (average 23 degrees ) was observed in six of 23 patients. Fifteen of 23 patients complained of penile shortening (average 1.8 cm). Two of 23 patients reported disturbing side effects that were caused by plication nodes. In most cases, the results of penile straightening by the Essed-Schroeder procedure are excellent with a high grade of subjective satisfaction. Regarding the main problem, that is recurrent curvature, there is no decisive advantage of applying Goretex sutures. Discomfort caused by plication nodes can be reduced to a minimum by using a combination of soft Goretex sutures with the 'inverting stitch-technique'.     

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.     

Ideal suture methods for skin, subcutaneous tissues and sternum

Non-absorbable sternal closure methods such as stainless steel wiring have been widely used, but biocompatibility and osteoconductivity of absorbable materials have advantages in acceleration of wound healing. Combined use of stainless steel wires with absorbable materials may contribute to minimizing sternal complications.Fascial tension reduction sutures, where the tension is placed on the layer of deep fascia and superficial fascia, are recommended for skin/subcutaneous closure. This means that the use of dermal sutures is minimized;indeed, dermal sutures can be avoided altogether if the wound edges can be joined naturally under very small tension. We prefer 0, 2-0 polydioxanone sutures (PDS II) for deep/superficial fascia sutures, 4-0 or 5-0 PDS II for dermal sutures (if they are necessary), and 6-0 or 7-0 polypropylene or nylon sutures (Proline or Ethilon) for superficial sutures. The consequence of such suturing is that the wound edges are elevated smoothly with minimal tension on the dermis that appears to prevent the development of large scars.     

Modified corporoplasty for penile curvature: long-term results and patient satisfaction

PURPOSE: In 1994 we began performing the modified corporoplasty technique in patients undergoing surgery to correct penile curvature. The procedure consists of transverse closure of the longitudinal tunical incisions. This technique allows minimal mobilization of the neurovascular bundles or corpus spongiosum and potentially decreases the risk of injury to underlying erectile tissue. We report long-term results of and patient satisfaction with this procedure. MATERIALS AND METHODS: From June 1994 to June 1997, 28 consecutive patients 16 to 65 years old (mean age 45) selected for corporoplasty underwent a total of 29 operative procedures for disabling penile curvature. The etiology of curvature was Peyronie's disease in 19 patients (68%) and congenital curvature in 9 (32%). Results were obtained by retrospective chart review and telephone interview. Long-term followup available for 19 patients ranged from 11 to 46 months (mean 24.1). RESULTS: Penile straightening was excellent in 25 patients (89%) and good with less than 20 degrees of residual curvature in 2 (7%). In 1 patient in whom the procedure failed excellent straightening was achieved after a repeat procedure. A total of 27 patients (96%) reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. We contacted 19 patients at long-term followup, of whom 17 and 2 reported excellent and good penile straightening results, respectively. In 18 cases there was no change in erectile rigidity, while in 1 there was early detumescence. Some element of erectile shortening without functional problems was noticed by 11 patients, of whom 1 was bothered by shortening but achieves successful intercourse. Eight patients denied shortening. In regard to the overall result 9 patients were very satisfied, 6 satisfied, 2 neutral and 2 unsatisfied. CONCLUSIONS: In select patients modified corporoplasty as described is an effective and durable procedure with a high rate of patient satisfaction. Patients should be counseled preoperatively concerning postoperative erectile shortening.     

Tunica albuginea plication for the correction of penile curvature

OBJECTIVE: To evaluate the efficacy of tunica albuginea plication (TAP) in the correction of congenital and acquired penile curvatures and determine key points for a successful outcome of this procedure. MATERIALS AND METHODS: From December 1995 to January 2001, 40 patients with penile curvature (10 congenital and 30 secondary to Peyronie's disease) underwent surgical correction by TAP. Indications were difficult or impossible penetration, normal erectile function, stable disease. For TAP we used non-absorbable inverted stitches tied with the assistant pushing down the tunica albuginea with a mosquito clamp to create an adequate groove for the knot. The results were evaluated subjectively and objectively. RESULTS: At mean follow-up of 30 months, full subjective and objective success (straight penis, mild shortening, normal erection, penetration and sensation) was achieved in 37 (92.5%) patients. Objective but not subjective success was achieved in 2 patients (5%), 1 complaining of psychogenic erectile dysfunction and the other of excessive penile shortening. There was only one failure, namely persistent glans numbness due to damage of the non-mobilized neurovascular bundle. CONCLUSIONS: TAP is a simple and effective method for the correction of congenital and acquired penile curvatures. Key points for successful outcome are adequate preoperative evaluation and counselling, careful preparation of tunica albuginea, mobilization of urethra or neurovascular bundle when needed, use of inverted stitches carefully buried, objective postoperative evaluation with a pharmacological erection test.     

Congenital and acquired penile deviation treated with the essed plication method

OBJECTIVES: To evaluate our results with the Essed procedure for the correction of penile curvature, either congenital or due to Peyronie's disease, and compare it with the data from the literature, both for the Essed and the Nesbit procedure. METHODS: From 1991 to 1996 the Essed procedure was performed in 61 patients. 65.6% (n = 40) had congenital deviation and 34.4% (n = 21) suffered from secondary deviation due to Peyronie's disease. In all patients 2-6 nonabsorbable inverting interrupted sutures were placed bringing the knot between the plicated tunica. RESULTS: Patients' ages ranged from 15 to 65 (mean 31.3) years and the mean follow-up time was 39.8 (12-75) months. The preoperative penile deviation was between 20 and 90 degrees (mean 47.4 degrees ). Eighteen patients (29.5%) had a recurrent deviation following surgery. This failure rate was higher in the patient group with Peyronie's disease (42.9%) than in the group with congenital deformation (22.5%). Postoperatively, 2 patients (3.3%) with Peyronie's disease reported de novo erectile dysfunction. Twenty patients (32.8%) complained of persistent discomfort or pain at the area of the still palpable plication sutures, but this inhibited sexual intercourse only in 1 case. 45.9% stated penile shortening after surgery but only 21.3% felt bothered by this. CONCLUSION: The results reported are in accordance with the literature showing a higher recurrence rate of the deviation with the Essed compared to the Nesbit procedure. For both methods the risk of recurrent disease is higher in patients with Peyronie's disease and with both techniques, an equally low incidence of erectile dysfunction is evident. However, since with the Essed technique one third of all patients complained of discomfort from the nonabsorbable sutures, the Nesbit procedure seems to be superior.     

Correction of complex penile deformities by modified nesbit procedure asymmetric tunica albuginea excision

PURPOSE: Penile angulation combined with penile torsion is an uncommon finding in case of congenital or acquired penile curvature. We describe our technique for treatment of complex penile curvature by the excision of asymmetric ellipses of tunica albuginea. MATERIALS AND METHODS: During the last 4 years, 4 patients with complex penile curvature underwent surgical correction by the excision of asymmetric ellipses of tunica albuginea. 3 patients had Peyronie's disease and 1 had congenital penile deviation. They ranged in age from 27 to 63 years. RESULTS: Convalescence was uneventful with good cosmetic correction of the penile torsion and lateral curvature in all patients. 1 patient reported shortening of the penis of about 2 cm, postoperatively. 2 patients reported decreased penile sensation, which resolved after 3 months. Erectile failure did not occur postoperatively in any case. CONCLUSIONS: During the last years many Authors have modified the original surgical procedure in an attempt to correct penile deformity. Unfortunately there are very few reports about correction of penile deformities combined with penile torsion. Our modified Nesbit surgical technique for complex deformities differs from the others with regard to the shape of the incision. In this manner, by shortening the longer corporeal body and creating a torque on the penis, it is possible to correct both problems: penile angulation and torsion. The technique is simple, bloodless, safe and reliable. In our experience good cosmetic and functional results have been achieved without complicated surgical interventions.     

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)     

Medium-term follow-up of plaque incision and porcine small intestinal submucosal grafting for Peyronie's disease

The best surgical option for the management of severe cases of Peyronie's disease is currently a matter of debate. To determine medium-term outcomes and complications after treatment of severe Peyronie's disease by porcine small intestinal submucosa (SIS) grafts, we retrospectively reviewed 33 consecutive plaque incisions followed by 4-ply SIS grafting in 28 patients (2002-2009). Postoperative complications, penile length preservation, de novo ED, penile curvature correction and curvature recurrence rates were recorded. Median patient age was 54 years (38-69 years). Median preoperative curvature was 90° (30-90°) (stable for at least 6 months). Six patients (21%) had preoperative ED. There were few postoperative complications (no cases of infection, haematoma (n=2), penile hypoesthesia (n=1), patch rejection and migration (n=1)). Subjective penile shortening and de novo ED were observed in 7 (25%) and 3 (11%) patients, respectively. The success rate for the procedure (straight penis or curvature ≤20° and ability to have intercourse) was 67% (22/33). Four patients achieved curvature correction after a repeat procedure with a new SIS graft. Eleven patients experienced recurrence within 3 months of surgery. After a median follow-up of 9 months (3-94), 22 patients (79%) had a satisfactory curvature correction.     

Modificated plication technique of the tunica albuginea in penis curvature correction

We present our penile curvature treatment experience in Peyronie's disease and cogenital curvature, using a modificated plication technique of the tunica albuginea with Prolene inverted sutures covered with Vicryl ones. The first suture gives security to the plication and the second one hides the first dots avoiding the nonabsorbable sutures bother.     

Treatment of penile curvature—how to combine the advantages of simple plication and the Nesbit-procedure by superficial excision of the tunica albuginea

Different treatment options for penile curvature exist, such as the Nesbit procedure with complete excision of the tunica albuginea or the simple plication. We prefer a modification with only superficial excision, not opening the corpora cavernosa. From January 1997 to June 2000, 68 patients were treated surgically due to penile curvature. Data was obtained from 48 patients by telephone interview. The mean penile deviation was 46 degrees. Excision of the tunica was performed only superficially and non-absorbable inverted sutures were used. The mean follow-up time in this study was 25 months. A total of 36 (75%) patients were satisfied postoperatively, 12 were unsatisfied. Eleven (23%) patients described a complete straightening, 37 (77%) a rest-curvature of 5-50 degrees (mean 14 degrees ) and 21 (44%) described a shortening of 0.5-5 cm (mean 1.2 cm). Six patients reported a recurrence. No new erectile dysfunction occurred. Superficial excision of the tunica albuginea offers the advantage of tissue-contraction due to scarring without destroying the integrity of the corpora, leading in combination with non-absorbable inverted sutures to good functional and cosmetic results.     

New technique with combination of felt, Hem-o-lok and Lapra-Ty for suturing the renal parenchyma in laparoscopic partial nephrectomy

We reported a new technique for closure of the renal parenchyma in laparoscopic partial nephrectomy, shortening the suturing time. Between 2009 and 2011, 41 patients with renal masses 4 cm or smaller in diameter underwent transabdominal laparoscopic partial nephrectomy by a single surgeon in a single institution. The sutures were carried out using 2-0 vicryl CT-1 with a 1.2 × 1.2 cm piece of felt, and both sutures were temporarily held using a Hem-o-lok. After all sutures (median 3) were completed, they were sequentially fixed by sliding the Hem-o-lok, and then locked using the Lapra-Ty. The median times for suturing the renal parenchyma and ischemic time were 13 min and 28 min, respectively. The arrangement of the wound and hemostasis were good. No patients developed urinoma or postoperative bleeding.     

Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita

ObjectiveCongenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology. We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature.MethodsBetween November 2010 and December 2020, we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery. Before the procedure, patients’ age, curvature location and degrees, as well as penile length were recorded. After the treatment, penile lengths were measured and recorded again. Early and late period results were recorded.ResultsPlication surgery was performed in 130 patients. The median age was 24 years.Seventy-six patients had ventral curvature, 22 had dorsal curvature, 32 had lateral curvature. Average shortening of penile length in patients with curvature below 30° was: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. Patients with curvatures above 30° were: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm.ConclusionPenile length shortening after plication is inevitable. Curvature degree and direction are factors affecting penile length after surgery. Therefore, patients and relatives should be informed in more detail about this complication.     

Prospective Randomized Blind Controlled Trial Comparing Sutures, Tape, and Octylcyanoacrylate Tissue Adhesive for Skin Closure After Phlebectomy

BACKGROUND: The patient's view of the outcome after phlebectomy is mainly dependent on the cosmetic result. OBJECTIVE: To compare 5-0 monofilament sutures with tapes and tissue adhesive for wound closure after varicose vein surgery. METHODS: Seventy-nine patients undergoing varicose vein surgery were prospectively randomized in three groups (tissue adhesive, sutures, tape) for skin closure and compared. The follow-up 1 year postoperatively was done by a senior dermatologist who was blinded in the method of skin closure. RESULTS: The cosmetic outcome showed little advantage for the suture group. Taping the incisions is faster than suturing them but without significance; closure with tissue adhesive takes nearly the double of time. The closure for one incision with tissue adhesive is 40 times more expensive than with tapes and 14 times more expensive than with sutures. CONCLUSION: This study failed to demonstrate an advantage of tissue adhesive and tapes over monofilament sutures for skin closure after phlebectomy.     

Octylcyanoacrylate skin closure in laparoscopy.

OBJECTIVES: Octylcyanoacrylate (Dermabond) is a dermal bond useful in closing surgical skin incisions. We compared skin octylcyanoacrylate with subcuticular skin sutures to close laparoscopic trocar sites. METHODS: A randomized, double-armed, prospective study was performed with 59 patients, in whom 228 trocar sites were closed. Twenty-nine patients underwent subcuticular closure of laparoscopic incisions, and 30 patients received closure with octylcyanoacrylate. Sutured trocar sites were closed with subcuticular 4-0 absorable suture. Octylcyanoacrylate wounds received closure in accordance with the recommendations of the manufacturer (Ethicon, Somerville, NJ). The number of sutures or vials of octylcyanoacrylate used, closure times, and postoperative wound problems were recorded. Wounds were assessed 2 weeks postoperatively for healing complications. Closure costs were estimated using published operating room time per hour plus the cost of octylcyanoacrylate or suture. The Student paired t test was used for statistical analysis. RESULTS: The overall mean time for skin closure using octylcyanoacrylate and suture was 3.7 minutes and 14 minutes, respectively (P<0.00001). An average of 2.2 packets of suture were used to close all port sites, while those closed with octylcyanoacrylate required an average of 3.4 vials per patient. Wound complications consisted of subcuticular seroma with skin separation. No difference was noted in complication rates between the 2 groups. Overall average cost per closure using octylcyanoacrylate was 198 dollars while cost for closure using suture was 497 dollars (P<0.00001). CONCLUSIONS: Laparoscopic port-site skin closure with octylcyanoacrylate is rapid and effective. Closure with octylcyanoacrylate yields cost savings and a decrease in operative time of more than 9 minutes per case.     

A modified corporoplasty for treating congenital penile curvature and reducing the incidence of palpable indurations

OBJECTIVE: To reduce the incidence of postoperative palpable induration after treating congenital penile curvature, using a modified corporoplasty technique. PATIENTS AND METHODS: In a retrospective unrandomized clinical trial, 105 patients with a congenital penile angulation of >30 degrees and for whom coitus was therefore difficult or impossible, underwent surgical correction. Of the 105 patients, 55 underwent the Nesbit-Kelami technique, whereby a diamond-shaped section of the tunica albuginea is excised and the defect closed with an interrupted suture. The remaining 50 patients underwent the modified corporoplasty, the edges of the tunica albuginea being brought together with a continuous, blood-tight, intratunical suture, and the end knots buried. RESULTS: The early results (<6 months) were comparable in both groups, with correction of the curvature in 94% and 95%, and postoperative complications in 14% and 15%. There were fewer postoperative haematomas in those undergoing modified corporoplasty (6% vs 18%). The late results (>6 months) also showed that these patients developed fewer palpable indurations (16% vs 44%). CONCLUSION: The modified corporoplasty reduced the incidence of postoperative haematoma and late complications (e.g. palpable indurations) after the surgical correction of congenital penile curvature.