Surgical decisions in Peyronie’s disease

In this review, we examine recent advances assisting surgical decision in Peyronie’s disease. Surgical treatment is indicated in penile deformities that have persisted for at least 6 months and functionally impair or preclude intercourse. Procedures shortening the longer side of the penis are invariably associated with length reduction, which may displease patients, despite penile straightening. Procedures lengthening the shorter side by means of grafting provide the best possible gain from a reconstruction procedure, although they may not restore the penis to its original length. Penile rectification and rigidity are required to achieve complete functional restoration of the penis. Most patients experience associated erectile dysfunction, and penile straightening alone may not be enough to restore complete function. Therefore, in some cases, phosphodiesterase inhibitors, self-injection, or a penile prosthesis may need to be added. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed.     

Addressing residual penile deformity in the Peyronie’s disease patient during penile implant surgery

Peyronie’s disease frequently presents as a painful curvature of the erect penis. Once stabilized, a proportion of patients will require a surgical intervention to correct the curvature. Reconstructive surgery should be considered separately in each patient as those with significant erectile dysfunction may be better suited to the implantation of a penile prosthesis, which will correct both the curvature and impaired erection. The erect penis usually is straightened after the prosthesis insertion, but in a minority of patients, some curvature remains. When this occurs, additional procedures will be necessary to straighten the penis by plaque incision (with or without grafting) or by the modeling technique. These additional techniques are necessary to improve patient satisfaction.     

Plaque incision and grafting represents the best surgical approach to the Peyronie’s disease patient: Con

Surgical treatment options for Peyronie’s disease include tunica shortening (Nesbit and plication) and grafting procedures. Tunica shortening procedures are associated with penile shortening. However, the amount of penile shortening is rarely significant for the patient. Although grafting procedures aim to prevent penile shortening, this may still be an issue due to the pathologic extent of Peyronie’s disease. Long-term postoperative erectile dysfunction is the major drawback. Many types of grafting material have been used, but only saphenous vein has gained certain acceptance. Grafting procedures must be restricted to patients with normal preoperative erectile status and excessive curvature. Nesbit or plication procedures may be associated with significant penile shortening. Grafting procedures are also indicated in cases of hourglass deformities, because they cannot be corrected by the Nesbit procedure. Nesbit wedge resection is still the gold standard for treating Peyronie’s disease.     

Penile dermatophytosis

Dermatophyte infections of the penis and scrotum are relatively rare compared with those involving the groin. Four cases of penile tinea due to Trichophyton rubrum are described. All patients had associated foci of fungal infection, but only one had crural involvement. Treatment with oral antifungal agents led to complete resolution of penile dermatophytosis.     

Mondor's disease of penis: a forgotten disease

BACKGROUND: Mondor's disease of penis is an uncommon genital condition involving the penile sulcus in a circumferential manner. Although this disorder is almost always self limited, it is associated with considerable psychological stress and sexual disharmony. METHODS: All patients attending the sexually transmitted disease clinic during 1991-2003 were examined for evidence of Mondor's disease of penis. Detailed history and clinical findings were recorded in a specially designed proforma. Histopathological examination and staining with CD31 and CD34 monoclonal antibodies was also done in 11 patients. RESULTS: 18 out of 1296 patients attending the sexually transmitted diseases (STD) clinic during the study period were found to have penile Mondor's disease, giving an incidence of 1.39%. 17 patients had history of one or more episodes of STDs. Histopathological specimens showed prominent vessels with plump endothelial cells and thickened blood vessel walls. The occasional vessel showed complete occlusion of its lumen. CONCLUSIONS: In our study we did not find any evidence of lymphatic involvement. Non-lymphatic vessels, mainly veins, were predominantly involved. In our opinion Mondor's phlebitis of penis or Mondor's disease of penis are better terms to describe the condition rather than non-venereal sclerosing lymphangitis.     

Current Concepts in Scrotal Reconstructive Surgery

Introduction

Scrotal reconstruction may be required in any setting where the patient sustains loss of a large area of scrotal or penile skin, as in repair of scrotal lymphedema and the adult acquired buried penis. Massive scrotal lymphedema and adult acquired buried penis are two conditions closely linked to obesity and are largely refractory to non-operative management. The demand for surgical repair of these conditions is increasing.

Purpose of Review

The aim of this article is to provide an overview of the preoperative considerations, surgical techniques, and postoperative outcomes in the repair of scrotal lymphedema and adult buried penis.

Recent Findings

Scrotal lymphedema and adult buried penis are associated with significant medical comorbidities and can cause sexual and urinary dysfunction. Surgical repair requires a multidisciplinary approach. Skin grafts are often required. There is no consensus regarding optimal postoperative management of these surgical wounds. Consideration should be given to extended duration chemical prophylaxis of thromboembolic events. Though complications are common, patient quality of life is significantly improved following repair.

Summary

The demand for surgical repairs of scrotal lymphedema and adult buried penis are increasing. Though patients have significant comorbidities and surgical repair may be complex, patient outcomes are good and quality of life can be greatly improved.

     

Advances in the Surgical Treatment of Peyronie’s Disease

Surgical treatment is the gold standard for correction of penile deviation in patients with Peyronie’s disease. Generally, plication techniques are applied when deviation is less than 60°, the patient has decreased erectile function, and penile length is satisfactory. Grafting techniques are indicated when deviation exceeds 60°, there is a short penis or an hourglass deformity, and the patient has good erectile capacity. In patients with erectile dysfunction refractory to medical treatment, penile prosthesis implantation with simultaneous correction of deviation is the optimal approach. This article summarizes some of the novel advances for each of these procedures, which have been reported in recent years. Surgical technique and outcomes of these techniques are described, and limitations set. Adequate preoperative counseling, including all options available today, is crucial before planning surgical treatment in Peyronie’s disease. Surgeon experience and careful patient selection for each procedure will remain the most determining factors for success.     

动脉性阳痿显微重建37例

目的：动永陆阳痿主要是阴茎动脉供血不足或缺乏所致。由于缺血、缺氧对阴茎输入、输出血管壁肉垫易纤维化,失去正常开放与舒张功能,进而加重了阳痿。通过动脉重建以改善阴茎供血、供氧,促使受损组织得以康复。方法：运用显微外科技术作腹壁下动脉-海绵体吻合2例;与阴茎背动脉端端、端侧吻合10例;与阴茎背深静脉端端吻合25例。本组采取端端、端侧、套入、血管移植等方法,全部作阴茎背深、脚静脉结扎。结果：术后随访5—60个月显效20例,占54．05％;满意12例,占32.34％;无效5例,占13．51％。结论：动脉性阳痿,不仅阴茎供血不足造成损害,而且影响或加重静脉系统关闭不全,一旦发生器质性改变,手术效果将不够理想。笔者主张动脉性阳痿尽早作动脉重建是较为理想的选择。