Plication corporoplasty for congenital penile curvature: our results with long-term follow-up

Objective

To evaluate the outcome of the long-term follow-up in patients who underwent corporoplasty-straightening treatment for congenital penile curvature (CPC).

Methods

Between 1989 and 2012, a total of 60 patients underwent corporoplasty-straightening surgery using penile plication for CPC. We followed up on all the correction of the curvature; (a) any penile shortening; (b) sexual function; (c) complications.

Results

The mean follow-up period was of 98 months. Complete correction of the curvature was obtained in 54 patients (90 %). Shortening of the penis (1.5 to not more than 3 cm) occurred in 16 patients (26.6 %). All patients had good erectile function (IIEF-5 > 21). The most frequent complication was the sensitivity reduction of the glans in five patients (8.3 %), which was resolved with in about a year after surgery (mean 11 months) and the shortening of the penis in 16 patients (26.6 %), which, however, did not result in problems during sexual intercourse.

Conclusions

Corporoplasty using penile straightening plication is a safe procedure whose results are maintained even after many years after surgery. It is a procedure that can be applied to any type of curvature. Any reduction in the length of the penis, as a result of the surgery procedure, does not lead to difficulties in sexual intercourse.     

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.     

A SURGICAL ALGORITHM FOR THE TREATMENT OF PEYRONIE''S DISEASE

Purpose

When conservative treatment of Peyronie's disease fails, the optimal surgical approach is not well defined. Multiple factors, including penile rigidity, degree of curvature, shaft narrowing with hinge effect and erectile response to vasoactive penile injections, indicate that no single approach is likely to solve the problem in all patients.

Materials and Methods

A surgical algorithm was developed for the treatment of Peyronie's Disease based on our previous surgical experience, which was used prospectively in 103 consecutive men. Penile straightening without prosthesis was offered to patients with adequate rigidity for coitus. Specifically, for mild to moderate curvature less than 60 degrees without hourglass or hinge effect deformity the less complicated tunica albuginea plication procedure was performed. For those men with more severe, complex curvature greater than 60 degrees and/or significant hourglass or hinge effect deformity plaque incision or partial excision with dermal grafting was offered to limit shaft shortening and to reconstruct a shaft with normal caliber to provide optimal axial support during intromission. For men with poor sexually induced erections and/or inadequate response to intracavernosal pharmacotherapy penile prosthesis placement was recommended to provide adequate straightening and rigidity.

Results

Of 22 patients who underwent plication procedures 91% remained potent and the penis remained straight postoperatively. Of 52 patients who underwent an incision or partial excision and grafting procedure, 48 had dermal grafts with the penis remaining straight in 94% and 75% remaining potent postoperatively. A total of 29 patients received a prosthesis with the penis remaining straight in 93% who were sexually active postoperatively. During the follow up period (mean 22.3 months) there have been no mechanical device failures.

Conclusions

Surgical outcome was optimized with this algorithm, which correlates surgical complexity to the underlying severity of the penile deformity and erectile capacity.     

Tunica‐sparing ossified Peyronie’s plaque excision

Study Type – Diagnostic (non‐consecutive series) Level of Evidence 3b What’s known on the subject? and What does the study add? Peyronie’s disease with heterotopic, ossified plaques require surgical removal. While conventional tunical excision techniques risk erectile and sensory compromise, we describe a tunical‐sparing technique which maintains potency with durable results.

OBJECTIVE

Ossified Peyronie’s plaques may require surgical excision because of the palpable problems and penile curvature that result. As tunical excision can result in impotence and decrease penile sensation, we describe a novel method of tunical preserving excision of such lesions.

PATIENTS AND METHODS

We evaluated 12 men with dorsal penile curvature between 10° and 90°. Penile plaque size ranged from 1 to 5 cm. 80% had painful erections. An artificial erection was induced with intracavernous injection of papaverine to assess penile deformity. Via a circumcising or ventral incision, plication sutures were placed to correct penile curvature. A lateral longitudinal corporotomy was made and the calcified/ossified portion was dissected free from the tunica albuginea/plaque of the corpora cavernosa. Watertight tunical closure was then performed.

RESULTS

Postoperatively, 80% of men reported erections always adequate for intercourse and normal sensation with a mean follow‐up of 7 months (range 2.1–14.5 months). All patients required simultaneous penile plication to ensure a straight phallus. Pathologic evaluation of plaque specimens all showed bone fragments.

CONCLUSION

Tunica‐sparing excision of the ossified/calcified portion of Peyronie’s plaques shows a durable benefit for large, ossified lesions and maintains potency and penile sensation.     

Incisional corporoplasty for the correction of congenital penile curvature: a review of two suturing techniques

This retrospective study was designed to evaluate the surgical outcome of correction of congenital penile curvature, via multiple vertical incisions in the tunica albuginea using two different types of suture material, simple inverted 2-0 PDS sutures versus Proline 2-0 suture followed by closure with 3-0 vicryl. The study included 45 men with congenital penile curvature and surgeries were performed in four general hospitals. Patients were divided into two groups; Group A (n=24) included patients undergoing penile curvature correction using 2-0 PDS sutures; and Group B (n=21) patients undergoing the same procedure by placing an inverted Proline 2-0 suture in the middle of the suture line and completing the closure of the incision line with 3-0 vicryl. The procedures straightened the penile shaft in all cases but a degree of curvature recurred in three cases (all Group A). No operative or postoperative complications occurred and no reoperations were needed. Four patients complained of penile shortening (all Group A). No recurrence was observed in the proline group (difference not statistically significant). Horizontal plication after vertical corporal incisions is safe and effective in the treatment for congenital penile curvature without hypospadias. We advise avoiding overcorrection to prevent penile shortening.     

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)     

Correction of congenital chordee penis by 'ventral separation and outward rotation of corpora'

Background/Purpose: The formation of congenital chordee penis in patients with or without hypospadias is multifactorial and not completely clear. In most cases, after release of all known causes of chordee, [ldquo ]residual[rdquo ] penile curvature can persist. The authors discuss the etiopathogenetic mechanisms of congenital chordee penis and describe their experience in surgical correction of [ldquo ]residual[rdquo ] penile curvature by [ldquo ]ventral separation and outward rotation of corpora.[rdquo ] Methods: In 22 patients with congenital chordee penis with or without hypospadias, [ldquo ]residual[rdquo ] penile curvature was corrected by [ldquo ]ventral separation and outward rotation of corpora.[rdquo ] Results: Ventral separation and outward rotation of corpora resulted in satisfactory correction of penile curvature. In only 2 cases of chordee penis without hypospadias was further intervention necessary: a Nesbit's plication was carried out in one and a neourethra placed in the other. At follow-up no residual penile curvature was observed. Conclusions: An arrest of development of the penis caused by failure of outward ventral rotation of the corpora, may contribute to the formation of chordee penis. When [ldquo ]residual[rdquo ] penile curvature persists, [ldquo ]ventral separation and outward rotation of corpora[rdquo ] can be used to correct this complex malformation. J Pediatr Surg 37:1347-1350.     

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.     

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.     

Buried penis: Classification surgical approach

Purpose

The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction.

Materials and Methods

Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1—29 patients with Longer Inner Prepuce (LIP) only, Grade II—20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III—12 patients who had in addition to the above, excess supra-pubic fat.

Operative Approach

A ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10).

Results

All 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%).

Conclusions

Congenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area.     

Management of chordee in children and young adults

Penile curvature is a spectrum of disease affecting boys with and without hypospadias. The etiology of chordee includes skin tethering, fibrotic bucks or dartos fascia, corporeal body disproportion and rarely a fibrotic urethra. Several surgical techniques (plication, excision, and graft insertion) are currently employed to repair penile curvature. Recent neuroanatomical studies of the developing fetal penis have shown that the dorsal nerve branches from the 11 and 1 o'clock positions to the 5 and 7 o'clock positions, being absent in the midline. Since the neuroanatomy is similar in both the hypospadiac and normal penis, we now recommend performing penile straightening in both hypospadiac and non hypospadiac patients with significant curvature by the placement of plication sutures at the 12 o'clock position. Placement of dorsal midline plication sutures corrects curvature without risk to the underlying nerve structures.     

The management of residual curvature after penile prosthesis implantation in men with Peyronie's disease

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To report our experience in the management of residual curvature after implantation of a penile prosthesis in men with Peyronie’s disease (PD).

PATIENTS AND METHODS

? From January 1985 to June 2009, 62 (29%) of the 209 patients with PD that have undergone the insertion of a penile prosthesis have required an additional straightening procedure to correct the residual curvature after the insertion of the cylinders of the implant. ? The types of additional manoeuvres, their success in correcting the residual curvature and eventual complications have been reported.

RESULTS

? Among the additional straightening procedures, modelling was more successful in achieving straightening when performed on an inflatable device (84%) than on a malleable implant (54%). ? If the curvature persisted after modelling or if the curvature was ventral, straightening was achieved with tunical plications or incision with or without grafting.

CONCLUSION

? Although it is common for the simple implantation of cylinders alone to straighten the penis, some patients will present a residual curvature that must be successfully corrected with additional straightening procedures.     

Surgical treatment of Peyronie’s disease by modified 16-dot placation in China

Objective

To assess the long-term patient’s satisfaction and functional results of surgical correction for Peyronie’s disease (PD) patients with penile curvature by 16-dot minimal tension placation and its modification in Chinese population.

Patients and methods

Between August 2004 and December 2008, 32 patients with PD underwent surgical correction of penile curvature by 16-dot minimal tension placation and its modification. Indications for operation included PD patients with penile curvature, adequate erectile capacity, difficulty or inability to vaginal penetration. Preoperative evaluation included International Index of Erectile Function 5 (IIEF-5) questionnaire score, pain on erection and physical examination. Patients were recommended daily low dose phosphodiesterase type 5 (PDE5) inhibitors two weeks after surgery and maintained for two months. At follow-up, patients and partner’s satisfaction and erectile function were assessed by IIEF-5 questionnaire score.

Results

There were no surgery-related complications, and 94% of patients and 88% of partners reported overall satisfaction after the surgery. Complete penile straightening was achieved in 27 (84%) patients. Slight residual curvatures were observed in 4 patients, which did not affect their sexual intercourse. All patients were satisfied with postoperative penile length while shortening of the penis was noted in 13 patients
(40%) with median penile length loss of 1.5 cm. In addition, no de novo erectile dysfunction was observed, and sexual function was significantly improved evidenced by the IIEF-5 scores, especially in the patients who have received PDE5 inhibitors for two months after two weeks surgery.

Conclusions

Correction of penile curvature using 16-dot placation and its modification is a simple and safe method to achieve cosmetic and functional satisfaction in carefully selected PD patients.     

上移阴茎阴囊交界部矫正隐匿型阴茎

目的 介绍矫正隐匿阴茎的一种简便而又有效的新术式。方法 采用阴茎与阴囊交界部弧形切口，切断牵拉阴茎的纤维筋膜，充分伸展阴茎，并将切缘皮下肉膜组织与海绵体脚筋膜固定，使阴茎阴囊交界部上移至正常解剖位置。结果 经10个月以上随访，53例患者均获满意外观，3例婚后性生活正常。5例术后阴茎皮肤水肿在一个月内消退。结论 上移阴茎阴囊交界部的术式，可使阴茎充分外露。     

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'.     

Peyronie disease: Our first experience with Ducket Baskin tunica albuginea plication (TAP) technique

IntroductionPeyronie's Disease is a deformity of the penis. Surgical procedure options for Peyronie's disease treatment include grafting (curvature >60°) or plication (curvature <60°). This case report emphasizes the curvature degree and therapy options chosen, such as tunica albuginea plication instead of grafting.Case presentationA 55-year-old male complains about a curved penis during erection. Examination shows penile bending 70° ventrally with ±15 cm length and 2x4cm size. The patient underwent Ducket-Baskin tunica albuginea placation (TAP). Postoperative unbent penis size decrement of ±3 cm, neither pain nor erectile dysfunction felt.Clinical discussionTunica plication is usually recommended in Peyronie's disease patients with curvature less than 60°, without an hourglass or hinge if grafting is not available. This technique is more simple, safe, the higher success rate of curvature correction (> 80%), low recurrency, low complication rate of penile hypoesthesia (approximately 10%), as well as low risk for postoperative erectile dysfunction.ConclusionIn our case, the tunica albuginea plication technique gives a good outcome in Peyronie's disease reconstruction.     

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.     

Radical bulbar dissection to correct severe chordee and proximal hypospadias

PURPOSE: We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. MATERIALS AND METHODS: Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. RESULTS: Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). CONCLUSIONS: This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.     

Peyronie's disease--incision and dorsal vein grafting combined with contralateral plication in straightening the penis.

OBJECTIVES: To evaluate the effectiveness of incisions of Peyronie's plaque and vein grafting combined with contralateral plication to straightening the penis. PATIENTS AND METHODS: Twenty-four patients with Peyronie's disease were treated surgically with a vein patch grafting technique to correct penile curvature. Median penile deviation was 70 degrees (range 60-90 degrees ), in 1 patient curvature was 30 degrees and all were unable to have normal sexual intercourse. The deep dorsal vein was excised and opened longitudinally. Transverse relaxing incisions about 1-2 cm long were made on the plaques at the point of maximal curvature, then, two other lateral incisions were made on both ends at 3 and 9 o'clock. The endothelial side of the harvested vein was placed in contact with the cavernous tissue to cover the defect created. Application of the contralateral surface of the tunica albuginea was performed in 21 cases to straighten the penis. RESULTS: After a median follow-up of 24 months, 19 patients were able to perform sexual intercourse, 3 patients who required intracavernous injection to maintain erection presented pre-operative adverse factors affecting erectile function. One patient returned to baseline pre-operative curvature. Twelve patients reported penile shortening, although only 5 patients were concerned about it. None of the patients permanently lost sensation in the glans of the penis. Palpable knots on the site of plication were reported in 5 patients. CONCLUSIONS: Plaque incision and placement of a deep dorsal vein patch graft, combined with contralateral corporeal plication, is a relatively simple, safe and effective alternative to correct angulations greater than 60 degrees.     

ANATOMICAL ALIGNMENT FOR THE CORRECTION OF BURIED PENIS

Purpose

We report a straightforward surgical technique for the correction and anatomical alignment of the skin in patients with various degrees of buried penis.

Materials and Methods

A combined series of 74 patients 7 months to 10 years old who were treated for buried penis at 2 institutions during a 7-year period. Patients presented with various symptoms, including balanitis, urinary tract infection, painful voiding, ballooning of the foreskin and urinary retention. In 29 patients (38%) trapped penis was due to previous circumcision. In our estimation the major anatomical defect in buried penis is an insufficient attachment of the dartos fascia and penile skin to Buck's fascia. Our technique involves making a circumferential incision of the inner preputial skin layer proximal to the corona, unfurling it from the shaft skin and leaving a coronal collar of approximately 1 cm. The annular band that usually constricts the corpora on retraction of the penile skin is incised, and the remaining proximal penile skin and dartos fascia are dissected off Buck's fascia proximally to the base of the penis. The penile dermis is sutured to the lateral aspect of the tunica albuginea at the penopubic junction and mid shaft of the penis. This technique restores normal anatomical relationships with excellent cosmetic results and negligible complications.

Results

At a median 5-year followup cosmesis was excellent in all case. Two patients with micropenis who required revision responded to endocrine therapy.

Conclusions

Excellent cosmetic results were obtained in all cases using this surgical technique.