Congenital penile curvature with orthotopic meatus : a report on the management of 62 cases following a systematic approach

Objectives We are presenting our experience with a systematic approach in the management of congenital penile curvature (CPC). Patients and Methods Between 1993 and 2000; 62 cases of CPC were treated. Ten of 34 cases (30) presenting with ventral curvature were corrected via excision of the dysgenetic tissue and complete mobilization of the corpus spongiosum only. Two cases (6) had a minimal corporeal disproportion that required a ventral longitudinal deep intercorporeal incision. Six cases (18) were managed with Nesbit's procedure; and tunica albuginea plication (TAP) was done in 8 cases (24). These cases required mobilization of the neurovascular bundle (NVB). Four patients (12) had a small phallus and required ventral grafts (dermal in two and venous grafts in another two). The remaining four patients (12) had a short urethra and were managed by excision of the tethering corpus urethrae and neourethral reconstruction. Cases presenting with lateral curvature (14 patients) were managed by a lateral longitudinal incision at the point of maximum curvature followed by TAP in 10 cases (71) and Nesbit's procedure in four (29). Dorsal curvatures (6 cases) were managed by ventral Nesbit in four (67) and ventral TAP in the remaining two cases (33). Patients with a complex curvature (8 cases) were managed by sequential TAP on an individual basis according to the results of intraoperative artificial erection in 5 cases (63) and by complete penile disassembly: The follow-up period ranged from 6 months to 2 years; and the results were satisfactory in the majority of patients. None of our patients developed impotence. Penile haematoma occurred in 6.4and penile numbness in 19(persistent in 3); while foreign body sensation was felt in 8. None of our patients experienced painful erections beyond three months after operation. A residual curvature was noticed in 9.6; and it required a second step Nesbit's procedure in only 3. Conclusion Management of CPC can result in a very high success rate as long as a systematic stepwise approach is applied with an appropriate preoperative patients counseling. We recommend the limited use of Nesbit's procedure (unless TAP fails to correct the curvature) together with a gentle handling of the NVB

Corporoplasty with saphenous vein graft in the surgical management of peyronie's Disease

Objectives The aim of this study is to evaluate the use of the saphenous vein in grafting the tunica albuginea defect after excision/incision of Peyronie's plaque in cases of disabling penile deformity. Patients and Methods A total of 12 patients with significant penile curvature due to Peyronie's disease interfering with their sexual activity were subjected to plaque excision/ incision and corporoplasty by saphenous vein patch grafting of the tunica albuginea. Results Penile straightening was achieved in 9 patients. One patient had a minimal residual curvature with induration at the graft site which; however; did not interfere with his sexual activity. Two patients complained of less rigid erections and are currently responding to oral measures and ICI. Penile numbness occurred in four patients with dorsal plaques; and it was self limiting within six months. We encountered no complaint of penile shortening or impotence. Conclusion The saphenous vein presents a reasonable alternative grafting material for the repair of tunica albuginea defects in patients with Peyronie's disease after plaque excision/incision. It is particularly useful in large plaque remnants and yields a satisfactory and appreciable outcome