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.     

Corporeal herniation after Nesbit plication with partial thickness shaving for congenital penile curvature

A 24-year-old man with penile congenital curvature who underwent partial thickness tunical shaving and plication with absorbable suture presented 1 month after surgery with a mass at the base of the right corpus cavernosum at the level of the original plication. We believe that corporeal herniation after tunical shaving and plication must be considered a complication of the technique independent from the type of suture used for the plicatures and probably related both to the opening of plications of the albuginea before permanent adhesion of the tunical layers, and to the decreased resistance of the albuginea, probably because of excessive shaving.     

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.     

Non-tensile tunica albuginea plication for the correction of penile curvature

Objective  

To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure.     

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.     

Corporeal reconstruction procedures for complicated penile implants

Implantation of a penile prosthesis is now a very much accepted mode of management of organic erectile impotence. In most situations, this operation will involve little or no corporeal reconstruction. However, in the presence of more severe pathologic processes that may lead to corporeal damage, such as infective corporitis secondary to an earlier penile prosthesis or postpriapism fibrosis, and with the increasing public awareness of the availability of therapeutic modalities for impotence, the urologist must be well versed in the diagnostic and surgical techniques of corporeal reconstruction.     

Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature

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

A new approach to the correction of the penile deformity in Peyronie's disease.

Nesbit's operation was performed on 23 of 160 patients with Peyronie's disease seen between January 1975 and July 1978. Details of the preoperative treatment and operative technique are provided. Normal sexual intercourse was resumed by 20 of the 23 patients and none had a significant residual deformity. It is suggested that Nesbit's operation is the procedure of choice in patients who do not respond to conservative treatment.     

The penile plication procedure: an alternative method for straightening penile deviation

The number of reported cases of congenital and acquired penile deviation is evidently increasing. We describe our experience with the penile plication procedure, which we used to treat 40 patients with penile deviation. Postoperatively, all patients regained the ability for sexual intercourse, with potency remaining unimpaired. Of the patients 96% were completely satisfied with the result of the operation. Sustained complications have not been observed. To avoid major trauma the surgical intervention should not include removal of ellipsoids from the penile tunica albuginea as proposed by Nesbit. Since the penile plication method produces equally good results in terms of performance and appearance, this therapy should be preferred.     

Simple dorsal plication near the 12 o''clock position for the correction of congenital ventral penile curvature

Fourteen patients with congenital penile curvature without hypospadias were treated with a modified Essed dorsal plication method between 1998 and 2002 in our clinic. Patient age ranged between 20 and 25 years (mean 22.2). Eight cases (57.1%) had ventral curvature only and six had an additional lateral curvature. There were no significant postoperative complications. One (7.1%) patient had early suture breakage on the 21st postoperative day during erection and underwent re-operation after 9 months. After a mean follow-up period of 23.2 months (range 3-46) all patients were satisfied with the procedure except for one patient (7.1%) who had a residual curvature of 20 degrees. Four cases (28.6%) had minimal shortening of the penis. The overall satisfaction rate with the procedure was 93%. Simple dorsal plication near the 12 o'clock position is a minimally invasive and effective method for the treatment of congenital ventral penile curvature.     

Home monitoring of penile tumescence for erectile dysfunction. Initial experience.

A technique using nocturnal penile tumescence monitoring has been developed to gather objective data on an outpatient basis. Patients have readily accepted the procedure and have easily learned to operate the monitor. Data from this group of controls and subjects are consistent with previously published reports by others. Suggestions are made from possible further refinements in technique.     

男子勃起功能障碍患者阴茎微循环检测

为了探讨男子勃起功能障碍（ＥＤ）患者阴茎微循环特点。检测２６例勃起功能障碍患者的阴茎微循环,与１７例健康志愿者进行比较。结果表明：器质性ＥＤ患者阴茎头微血管密度（２７．１±５．２,对照组为４７．８±６．２）和异常微血管百分率（３２．１±３．４,对照组为１２．８±１．３）均明显异于对照组,Ｐ＜０．０１;心理性ＥＤ患者的这两项指标与对照组相比没有统计学差别（血管密度４７．２±６．８,对照组为４７．８±６．２;异常血管百分率１３．１±１．１,对照组为１２．８±１．３,Ｐ均＞０．０５）。结论：器质性ＥＤ患者的勃起功能障碍与阴茎头微循环改变有关,其临床意义有待深入研究,阴茎头微循环检测可用于器质性ＥＤ的辅助诊断。     

Corporeal septal necrosis secondary to penile cylinder aneurysmal dilatation

A case report of necrosis of the corporeal septum secondary to aneurysmal dilatation of a penile prosthesis cylinder is presented. Recommendations are made for surgical management.     

Current role of penile implants for erectile dysfunction

PURPOSE OF REVIEW: The purpose of this review is to appraise new developments and publications in the field of penile prosthetic surgery. Urologists dealing with erectile dysfunction need to recognize the value of penile prosthetic surgery as a very efficacious treatment for this common condition. This type of surgery is needed in a considerable proportion of patients with erectile dysfunction so this review is timely and relevant. RECENT FINDINGS: The main themes in the literature covered include risk factors for infection of penile prostheses, its prevention with the use of hydrophilic and antibiotic-coated prostheses, particularly in re-operations, and its management with the new rescue procedures. Surgical tips for prosthetic surgery are also reviewed as well as clinical outcomes and factors influencing them. SUMMARY: Of all the invasive treatments currently available, placement of a penile prosthesis is one of the most successful, giving high levels of satisfaction. With the aid of new technical advances, the risk of infection--the most feared complication--can be minimized so prosthetic surgery may play a major role in the treatment of erectile dysfunction.     

非性交勃起在勃起功能障碍患者阴茎康复中的应用

勃起功能障碍(ED)是临床上常见的一种男科疾病,有研究显示40~70岁的男性ED患病率约52%,且日益趋向年轻化。目前认为,缺氧是ED的独立危险因素,其导致ED的机制复杂多样。近年来,阴茎康复理念备受重视,这一理念的引导实施是通过增加海绵体组织氧供,降低组织纤维化和凋亡以促进勃起功能恢复正常。而针对增加海绵体组织氧供的一些非性交勃起手段,如行为治疗、药物治疗、真空负压吸引装置治疗、海绵体内注射治疗等,可在一定程度上模拟男性正常自然性交勃起,帮助患者进行有效的阴茎康复锻炼。本文就目前非性交勃起治疗在阴茎康复中的应用作一论述。