ABSTRACT
To assess the efficacy of an inner preputial skin flap as replacement for the tunica albuginea of the corpus cavernosum after excision of fibrous plaque. Patients and Methods In this retrospective study we evaluated 5 men who presented with impotence; chordee; painful erection and/or painful coitus after previously undiagnosed or untreated penile fracture. In two patients soft tissue X-rays suggested calcification of the plaque; while ultrasonography revealed extension of fibrosis in four cases. In all patients the plaque was excised and the defect in the tunica albuginea was closed with an inner preputial pedicle skin flap. Results The flaps had taken well in all cases at 3 months follow-up and all patients reported having normal sexual intercourse. Conclusion Surgical excision is the treatment of choice for management of symptomatic fibrous plaques occurring in undiagnosed; untreated or conservatively managed penile fracture. A defect of more than 1.5 cm after excision of the plaque requires tunica replacement; and an inner preputial flap is a good replacement
Subject(s)
Disease Management , Foreskin , Penile Induration/therapy , Surgical FlapsABSTRACT
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. Patients and Methods: From June 2004 to July 2007; 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie's disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration; and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycronr 2/0 polyester fiber). Results: After a mean follow-up period of 18 months; successful results with respect to penile straightening; normal erection; penetration and sensation; confirmed both subjectively and objectively; were achieved in all patients. Post-operative penile shortening of less than 1.5 cm was present in 50of the cases; but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100(35/43 very satisfied and 8/43 satisfied). Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful appropriate expectations; and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle; which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea; which may prevent postoperative erectile dysfunction; is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity
Subject(s)
Penile Induration , Postoperative Complications , Urologic Surgical ProceduresABSTRACT
Objective To evaluate the efficacy of intra-lesional verapamil injection in the treatment of Peyronie's disease. Patients and Methods Twenty-six patients with Peyronie's disease were divided into two groups: the verapamil treatment group (study group) including 13 patients and the saline group (control group) including another 13 patients. The patients' age ranged from 35 to 58 years with a mean age of 43.75 years. The patients in the study group were subjected to a weekly injection of 10 mg verapamil hydrochloride (5 mg / 2 ml) into the plaque for the duration of six weeks. At the same time; the patients in the control group received a weekly injection of normal saline into the plaque; also for the duration of six weeks. The patients' response to the injections was evaluated subjectively with respect to pain and sexual dysfunction and objectively with respect to the plaque volume and the degree of curvature. Results Following therapy; pain was improved in 8 of 9 patients (88.9) of the patients in the verapamil group; while in the control group it was stationary in 6 of 8 patients (75) and had progressed in 2 of 8 patients (25). Curvature was improved in 5 of 10 patients (50) and remained unchanged in 5 of 10 patients (50) of the study group; while no improvement could be recorded in any of the patients of the control group. Three of five patients (60) of
Subject(s)
Egypt , Injections, Intralesional , Penile Induration , Penile Induration/therapy , Verapamil/administration & dosageABSTRACT
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
Subject(s)
Penile Induration , Saphenous Vein , TransplantsABSTRACT
Objectif L'analyse des aspects diagnostique; therapeutique et evolutif de la rupture traumatique du corps caverneux (RTCC) a travers l'etude d'une serie de 42 cas et d'une revue de la litterature. Patients et Methodes L'age moyen des patients est de 32 ans; le mecanisme le plus frequent est la manipulation forcee de la verge en erection. L'examen clinique permet de localiser le siege de la fracture (proximal: 60; distal: 40). La fracture etait unilaterale dans 40 cas et bilaterale chez 2 patients presentant une rupture associee de l'uretre. Resultats Quarante patients ont ete operes; dont 35 en urgence; ces derniers ont tous evolue favorablement. Les interventions tardives (5 cas) ont ete grevees de com-plications (2 cas de plaque fibrose; 1 cas de coudure de la verge). Les deux patients non operes par refus de la chirurgie ont evolue vers une induration angulaire severe. Conclusion La RTCC est une affection de l'adulte jeune qui necessite un traitement chirurgical precoce avec un abord adapte au type des lesions
Subject(s)
Penile Induration , Rupture , Urogenital Surgical ProceduresABSTRACT
Objectifs L'evaluation des resultats a long terme de l'operation de Nesbit dans le traitement de la coudure de verge. Patients et Methodes Trente-neuf cas de coudure de verge (20 coudures congenitales et 19 coudures secondaires a la maladie de Lapeyronie) ont ete operes dans le service d'urologie de l'Hopital Edouard Herriot de Lyon sur une periode de 10 ans. L'operation de Nesbit a ete pratique dans 74des cas; et dans les autres cas; une variante de celle-ci. Le principe de l'operation de Nesbit est simple. Il consiste a exciser une pastille ovalaire d'albuginee et de corps caverneux au sommet de l'angle de la coudure. Resultats Le redressement de la verge a ete obtenu et maintenu des la premiere intervention dans 97des cas apres 6 mois. La correction est toujours stable a 10 ans. Un seul cas de raccourcissement important de la verge (2 cm) a ete note. Conclusion L'operation de Nesbit est une intervention fiable; bien codifiee actuellement. Elle donne entre les mains entrainees d'excellents resultats