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Three anatomical levels: possibilities to decrease invasiveness of reconstructive surgery for congenital penile curvature.

ABSTRACT: The aim of the study was to report methods - based on penile anatomy - leading to the minimization in the invasiveness of reconstructive surgery for congenital penile curvature (CPC).From 2006 to 2016 authors operated on 186 adult men with CPC.To avoid degloving, the authors used the longitudinal skin and tunica dartos incision. For decreasing invasiveness to the dorsal neurovascular bundle (NVB), the authors separated it only locally in the shape of a triangle or a trapezium, elevating it only over the place of the tunical reconstruction. To decrease the invasiveness for the tunica albuginea (TA) and cavernous vessels, a new operative technique based on the stratified structure of the TA was developed in which the corpora cavernosa were not opened. During reconstruction, only the elliptical fragment of the external layer of the tunica was excised (internal layer was left intact) and both layers of the tunica were sutured over the invaginated internal layer.Follow-up ranged from 6 months to 10 years. In all the patients, the penis was straightened during operation. Follow-up examinations were done 6 months and 1 year postoperatively. Disorders of superficial sensation on the glans, erectile dysfunction or chronic postoperative edema were not detected in any of the 186 patients. The penis remained straight in 180 patients (96.7%). In 4 patients (2.2%) in whom the primary curvature was 80-90 degrees and the postoperative curvature was about 30 degrees, reoperation was done. In two patients (1.1%) with the remaining postoperative curvature up to 20 degrees and good functional result (patient's opinion), there was no need for further treatment.Longitudinal skin and tunica dartos incision on the convex surface of the penis allows for the ability to avoid penile degloving and to preserve the foreskin. Elevation of the dorsal NVB from the TA was done on a very limited surface in the shape of triangle or trapezium, in order to decrease the possibility of dorsal nerves/vessels damage. Excision of elliptical fragments of the external layer of the TA with subsequent invagination of the internal layer, excluded the need for opening of the corpora cavernosa as well as for the use of a tourniquet during reconstruction. This diminished the potential risk of complications, especially intra- and postoperative bleeding.

SUBMITTER: Perdzynski W

PROVIDER: S-EPMC5656374 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Three anatomical levels: possibilities to decrease invasiveness of reconstructive surgery for congenital penile curvature.

Perdzyński Wojciech W Adamek Marek M

Central European journal of urology 20170822 3

<h4>Introduction</h4>The aim of the study was to report methods - based on penile anatomy - leading to the minimization in the invasiveness of reconstructive surgery for congenital penile curvature (CPC).<h4>Material and methods</h4>From 2006 to 2016 authors operated on 186 adult men with CPC.To avoid degloving, the authors used the longitudinal skin and tunica dartos incision. For decreasing invasiveness to the dorsal neurovascular bundle (NVB), the authors separated it only locally in the shap ...[more]

PMID: 29104792

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Project description:BackgroundNumerous surgical techniques are available for the correction of isolated ventral congenital penile curvature (IVCPC). This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique.Materials and methodsThis prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea (Essed-Schroeder technique) with a covering pair of absorbable sutures. The primary outcomes were successful correction (defined as a residual curvature ≤15 degrees) and patient satisfaction. Postoperative follow-ups were performed at 3, 6, and 12 months.ResultsA total of 23 patients were treated for IVCPC with a mean (range) age of 25.3 (18-31) years. Eighteen patients (78.3%) were single with cosmetic complaints, whereas the other 5 patients (21.7%) were married and presented with a difficult vaginal intromission. The mean (range) curvature, length, and operative time were 40 (30-50) degrees, 15 (10-19) cm, and 82 (65-100) minutes, respectively. Postoperative penile pain and numbness occurred in 13 patients (56.5 %) and 7 patients (30.4%) only within the first month, respectively. Palpable suture knots were reported in 15 patients (65.5%) without being bothersome up to 12 months. The postoperative means (ranges) of penile curvature and length were significantly different from that of the preoperative values at 3 (5 [0-20] degrees and 14.5 [9-18.5] cm), 6 (5 [0-20] degrees and 14.5 [9-18.5] cm), and 12 months (5 [0-30] degrees and 14.5 [9-18.5] cm; all p < 0.001). Age, preoperative penile curvature, penile length, postoperative pain, wound infections, and knot palpation insignificantly affected curvature recurrence. Seventeen patients (73.9%) were very satisfied with their surgical outcomes.ConclusionsIncisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.

Project description:Hypothesis/aims of studyMayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea. The ESHRE/ESGE categorizes this disorder within the class 5 uterine malformation of the female genital tract anomalies. It is characterized by congenital absence of the uterus, cervix, and upper part of the vagina in otherwise phenotypically normal 46XX females. These patients have normal ovaries, biphasic ovarian cycle, and female psychosexual identification. Laparoscopic Vecchietti's operation-surgical method in which the vagina increases in size by gradually applying traction to the vaginal vault-is one of the methods used to treat MRKH. The aim of this study was to establish the urogynecological and sexual functions after Vecchietti's operation.Study design materials and methodsFifteen patients with MRKHS who underwent laparoscopic Vecchietti's operation were included. A control group of 15 age-matched, childless, sexually active women were examined during the same period. All patients underwent the basic evaluation of anatomical outcomes. Sexual outcomes were established by the Polish validated Female Sexual Function Index (FSFI) questionnaire. Continence status was assessed by Polish validated Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7).ResultsMean age of MRKH group was 22.06±5.13 yrs. Mean follow-up after surgery was 8.02±3.43 yrs. Mean age of women from control group was 22.4±4.35. Mean FSFI scores show good quality of sexual life in both groups. UDI-6 scores showed that patients after Vecchietti surgery have urogynecological problems significantly more often than healthy women do. Based on the IIQ-7, it is evident that one patient from the MRKH group (6,6%) suffers from stress urinary incontinence and the rest (20%) have rather irritative problems with the functioning of the lower urinary tract.ConclusionQuality of sexual life after the Vecchietti's operation in long-term follow-up does not differ from that of healthy women, but these patients suffer more frequent from urogynecological complaints. The trial is registered with NCT03809819.

Project description:Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate 'normal' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient's overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were "penile lengthening", "penile enhancement", "penile girth", "inflatable penile prosthesis" and "glans augmentation". Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.

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Three anatomical levels: possibilities to decrease invasiveness of reconstructive surgery for congenital penile curvature.

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Three anatomical levels: possibilities to decrease invasiveness of reconstructive surgery for congenital penile curvature.

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