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Hypospadias is a common congenital malformation in the male urethra and external genitalia, which can be successfully treated with surgery. Various surgical treatments are available. Based on the repair criteria for restoring function and appearance, surgical treatments require the complete correction of the penile curvature, repair of the urethra to the head of the penis, and acquisition of a fissure-like opening. The local anatomical characteristics of hypospadias should be taken into consideration to formulate an individualized surgical treatment plan.
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Objective:To evaluate the therapeutic efficacy of interposition urethroplasty on glandular hypospadias and severe penile curvature.Methods:A total of 9 cases of congenital glandular hypospadias and 2 cases of congenital severe penile curvature (>30°) treated with the interposition urethroplasty technique in the Shenzhen Children′s Hospital from November 2008 to December 2019 were retrospectively analyzed.The mean age of initial surgery was 40 (25-109) months.Two cases were surgically treated with one-staged interposition urethroplasty and the remaining were treated with two-staged interposition urethroplasty.They were followed up for 8 months to 12 years, including the penile morphology, urination, urethrocutaneous fistula, urethral stricture and uroflowmetry.Continuous variables were presented as ± s deviation, Student′s t-test was used for comparison between groups. Results:The median length of interposition urethra was 3.2 (2.2-4.2) cm.The cosmetic appearance of penis was good without residual chordee, urethral stricture or urethral diverticulum in all patients.Two cases had urethrocutaneous fistula(one-staged repair and two-staged repair were performed in one case respectively), which were successfully repaired by re-operation.The maximum of uroflowmetry in patients at 3 months [(8.3±1.0) mL/s] and 6 months [(6.7±1.9) mL/s] after surgery was significantly lower than that of children in healthy control group [(10.5±3.7) mL/s] ( t=3.221, 3.864, all P<0.05). However, there was no significant difference in 1-year maximum of uroflowmetry postoperatively between surgically treated patients [(10.5±3.7) mL/s] and healthy control group ( P>0.05). Conclusions:Interposition urethroplasty is an effective and safe treatment for glandular hypospadias and/or severe penile curvature in children.
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General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.
Subject(s)
Humans , Male , Erectile Dysfunction/surgery , Patient Satisfaction , Pelvic Pain , Penile Induration/surgery , Penis/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To investigate the therapeutic effect of dorsal skin-tightening technique on the correction of mild penile curvature in children with hypospadias.Methods:The clinical characteristics of hypospadias patients (95 cases) with mild penile curvature (<30°) after degloving penis during operation in our hospital from Jan 2017 to Sep 2020 were analyzed retrospectively. Group A: A new technique, reconstructing penile pubic angle at 12 o'clock position of penile dorsal side after degloving and suturing forskin outer and inner plate with tension at 12 o'clock position, was performed in dorsal skin-tightening group (43 cases). Gtoup B: while in dorsal midline tunica albuginea plication group (52 cases), Buck fascia was incised on dorsal midline area, following by tunica albuginea plication with one or two stitches. The patients in Group A were 0.4 to 1.5 years old, and the median age was 1.1 years, urethral orifice were located on distal shaft in 36 cases, proximal in 7 cases.The patients in Group B were 0.5 to 2.6 years old, and the median age was 1.5 years, urethral orifice were located on distal shaft in 41 cases, proximal in 11 cases. The penile ventral curvature degree was recorded during regular follow-up (postoperative 6 and 12 months), as well as postoperative complications.Results:Artificial erection test showed penile curvature was corrected during surgery by measuring with protractor. There was no chordee by measuring with the side photos in all patients during an average of 1.6 years follow-ups. There were 4 case of urethral fistula in Group B and 3 cases in Group A. No cases of urethrostenosis, diverticulum or concealed penis was recorded. The difference of postoperative complications had no statistical significance.Conclusion:Hypospadias with mild penile curvature could be effectively corrected by dorsal skin-tightening technique, which showed a good result of early follow-up.
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Urethral fistula caused by anterior urethral valve combined with penile curvature is a rare clinical disease, which is rarely reported at home and abroad. We diagnosed 2 cases, treated with urethral diverticulum resection + urethral valve resection + dorsal albuginea of the penis + Duplay one-stage urethroplasty and urethral diverticulum resection + urethral valve resection + penis Dorsal albuginea fold + Duckett one-stage urethroplasty respectively. There were no surgical complications such as penile recurvation, urinary fistula, urethral stricture or urethral diverticulum, during the follow-up period of 10 and 15 months.
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Surgical correction can be considered for treating patients with a chronic phase of Peyronie's disease (PD) and persistent penile curvature. In clinical practice, some patients pay too much attention to surgical complications and refuse the recommended feasible surgical types. Meanwhile, they require operations according to their preferences. This study aimed to evaluate the effects of patients' own choice of surgical type on postoperative satisfaction. This retrospective study analyzed data from 108 patients with PD who underwent surgical correction according to doctors' recommendations or patients' own demands. The objective and subjective surgical outcomes were assessed. Patients' understanding of the disease was analyzed using a questionnaire survey. Objective measurements of surgical outcomes, including penile straightening, penile length, and sexual function, in patients who received the recommended surgery, were similar to those in patients who did not accept the recommended surgery. However, subjective evaluations, including erectile pain, discomfort because of nodules on the penis, and decreased sensitivity in the penis, were more obvious in patients who did not follow doctors' recommendations. In addition, a questionnaire survey showed that understanding PD and the purpose of surgery of patients who did not follow doctors' advice were inappropriate, as they did not conform to the principle of treatment. The present study showed that surgical correction seemed to be an objectively effective option in the management of patients in the stable chronic phase of PD. Low patient satisfaction might be related to patients' lack of correct understanding of the disease and its treatment strategy as well as unrealistic expectations.
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Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.
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Background: Peyronie’s disease is an inflammatory, fibroticpenile disorder affecting men in age range of 19-83 years. Itoccurs as an acute or chronic phase and rarely cases resolveon their own. Several treatment options are available includingoral, intralesional and surgery. Although several clinical trialshave been performed, they lack significant and corroboratedresults hence there is a need to attempt prospective researchto elucidate the most effective therapies. The aim of this studyis to determine the efficacy of intralesional injection ofverapamil over normal saline.Methods: This was a randomized parallel group studyconducted between March 2013 and February 2017 whichrandomized patients with Peyronie’s disease into two groups toreceive verapamil or normal saline intralesional injections, withinclusion criteria of penile curvature with or without plaque.After 6 biweekly injections, all above parameters andsatisfaction score was reexamined. Patients were evaluated byhistory, physical examination, questionnaire, ultrasonographyand color Doppler study of the penis.Results: A total of 53 patients were enrolled (verapamil, n=28;control, n=25). Overall, among verapamil group attenuatedcurvature, erectile dysfunction and reduced plaque size werefound in 82%, 64.2%, 67.8% of and 60.7of patientsrespectively. Pain decreased in both groups considerable to97% and 91%. Overall satisfaction level was higher inverapamil group that is82% to control group of 40%.Conclusion: Intralesional verapamil is a good treatmentchoice with absence of invasive procedures and overall goodsuccess rate and patient acceptability.
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Objective@#To investigate the risk factors for the complications of urethroplasty in patients with primary hypospadias by postoperative follow-up observation.@*METHODS@#We retrospectively analyzed 110 cases of primary hypospadias repair performed from November 2010 to October 2015, including 70 cases of tubularized incised plate (TIP) urethroplasty and 40 cases of inlay internal preputial graft (IIPG) urethroplasty, all with the urethral plate reserved. We followed up the patients for 15.6－36 months, (27.3 ± 0.52) mo for those with and (26.9 ± 0.22) mo for those without complications. The mean age of the two groups of patients was (7.5 ± 0.2) and (7.0 ± 0.5) yr, respectively.@*RESULTS@#The follow-up data were collected from all the patients, 17 (15.5%) with and 93 (84.5%) without complications. The success rate of surgery was 84.5%. There were no statistically significant differences in the follow-up time and age between the two groups of patients (P >0.05). Single-factor analysis of variance showed significant differences between the complication and non-complication groups in the preoperative urethral opening (P <0.01), ventral penile curvature (P <0.01), and length of urethral defect (P = 0.04), while multiple linear regression analysis exhibited that only ventral curvature was associated with the postoperative complications of the patients (OR = 1.12, 95% CI: 1.06－1.19, P<0.01).@*CONCLUSIONS@#We chose single-stage urethroplasty with the urethral plate reserved for the treatment of primary hypospadias and achieved satisfactory outcomes. Ventral penile curvature is an independent risk factor for the complications of primary hypospadias, and a higher degree of curvature is associated with a higher incidnece of complications.
Subject(s)
Child , Humans , Male , Analysis of Variance , Foreskin , Transplantation , Hypospadias , General Surgery , Penis , Postoperative Complications , Postoperative Period , Plastic Surgery Procedures , Regression Analysis , Retrospective Studies , Risk Factors , Treatment Outcome , Urethra , General Surgery , Urologic Surgical Procedures, MaleABSTRACT
Many different materials are available for grafting during surgery for Peyronie's disease (PD). To study the outcomes associated with the use of a lyophilized bovine pericardium graft (Peri-Guard®) to repair tunical defects in patients with PD, descriptive study of 43 patients with disabling penile curvature was performed. Curvature was measured before and after the intervention using a standardized procedure. Surgical technique was plaque excision and grafting of the tunical defect carried out by a single surgeon. A lyophilized bovine pericardium patch was used for grafting. We measured the change in penile curvature and length, the ability to perform successful sexual intercourse without further pharmacological or surgical treatment, and the satisfaction with treatment. Follow-up data were available for a total of 41 patients. Median age was 50 years (IQR 48-52); mean follow-up time was 14 ± 6 months. Complete penile straightening was achieved in 33 patients (80.5%) and five patients (12.2%) had curvature under 20°. Three months after surgery and stretching therapy, mean (s.d.) flaccid penile length increased from 11.2 ± 2.8 cm to 12.1 ± 2.9 cm (P = 0.062). Seventy-five percentage of patients reported being able to achieve successful intercourse without further treatment. Eighty-five percentage of patients reported to be satisfied with the treatment. There was no evidence of tissue rejection or infection, and only four patients suffered an adverse event. Plaque excision and grafting of the tunical defect with lyophilized bovine pericardium seems to be a safe and effective treatment for patients with PD.
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Objective To assess the long-term surgical outcomes,patient's satisfaction and functional results of correction for patients with penile curvature by 16-dot minimal tension plication.Methods Between August 2004 and December 2010,92 patients with penile curvature underwent surgical correction of penile curvature by 16-dot minimal tension plication.Of them,86 patients (53 patients with congenital penile curvature and 33 patients with Peyronie's disease (PD)) were reached for long-term follow-up.Indications for operation included patients with 30 to 90 degrees of penile curvature,penile length greater than 10 cm and patients who had one or more symptoms,such as difficulty or inability to vaginal penetration and partner discomfort during sexual intercourse.Patients were excluded from study if they had severe penile curvature (greater than 90 degrees),hourglass deformities or large plaques.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 (PDE-5) inhibitors 2 weeks after surgery and maintained for 2 to 3 months.At follow-up,recurrence rate,complications,erectile function,patients and partner's satisfaction with the surgery were assessed.Results The mean time of follow-up was 79 months (range,35-107 months).Of 86 patients who had been reached for long-term follow up,82 patients (95.3％) and 77 partners (89.5％) reported overall satisfaction after the surgery.Complete penile straightening was achieved in 79 patients (91.8％).Slight residual curvatures were observed in 7 patients,but did not affect their sexual intercourse.Postoperative penile length shortening (median penile length loss 1.3 cm) was noted in 35 patients (40.7％),which did not affect their sexual intercourse.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 had received PDE-5 inhibitors for 2 to 3 months.There were no surgery-related complications,such as hematoma,urethral injury,or infection.Conclusion The longterm results demonstrate that correction of penile curvature using 16-dot plication is a simple and safe method to achieve cosmetic and functional satisfaction in patients with mild to moderate penile curvature.
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ObjectiveTo evaluate the effect of lengthening the short-side albuginea of the bending penis by the allogeneic acellular dermal matrix ( Allo-ADM ) for the treatment of penile curvature.MethodsFrom Jun 2007 to Jun 2010,18 patients with penile curvature due to malformation of the albuginea cavernous body were treated.The age of the patients ranged from 15 to 26 years (mean,20 years).Twelve patients were married.The curvature degree ranged from 30° to 80° (mean,55°).There were 17cases of single curvature and 1 case of complex curvature.The grafts ( Allo-ADM ) of different sizes were sutured to the albuginea at the curvatus side of the penis according to the extent of penile curvature through a circumcision incision.The extent of penile curvature and complications were evaluated postoperatively.ResultsPenile curvature was corrected in all 18 patients after the operation.No infection,hematoma and abnormal erection occurred postoperatively. No erectile dysfunction and penile re-curvature was observed during the follow-up period of 3 to 24 months.ConclusionLengthening the short-side albuginea of the bending penis by Allo-ADM could be a safe and effective way to correct penile curvature.
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O chordee é a causa mais comum de curvatura ventral na hipospadia e também em muitos casos de curvatura ventral sem hipospadia esta última não é muito assinalada. A curvatura ventral sem hipospadia é um defeito congênito decorrente da ação insuficiente dos hormônios produzidos pelos testículos, os quais estimulam o desenvolvimento masculino. Clinicamente, chordee sem hipospadia é uma curvatura ventral entretanto, o meato da uretra está localizado em sua posição normal na glande e o tecido fibroso é o principal responsável pelo encurvamento. Para a correção da angulação do pênis, várias técnicas cirúrgicas têm sido descritas. Todavia, adotando um conceito diferente sobre a curvatura ventral, tenho utilizado o método progressivo para corrigir a deformidade. Acredito que, em princípio, a clássica excisão do tecido fibroso da face ventral até o meato uretral é o procedimento mais apropriado e frequentemente será suficiente para conseguir a adequada retificação do falo.
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Humans , Male , Penile Diseases/genetics , Hypospadias/diagnosis , Genitalia, Male/abnormalitiesABSTRACT
Objective To investigate the surgical managements and effects of congenital islated penile curvature. Methods The degloving of penile shaft,penile dorsal tunical plication,urethral division and urethroplasty were performed in 23 patients with this entity including 2 cases of type Ⅰ,11 cases of type Ⅱ,6 cases of type Ⅲ,4 cases of type Ⅳ,mean age 7 years (age 1 to 21 years). Results Of all 23 patients 17 cases of type Ⅱ and Ⅲ were succesfully repaired by degloving of penile shaft;1 case of type Ⅰ,by degloving of penile shaft and dorsal tunical plication;1 case of type Ⅰ and 2 cases of type Ⅳ,by degloving of penile shaft,dorsal tunical plication and urethral division;2 case of type Ⅰ and Ⅳ,by urethroplasty.One case was complicated with urethrocutaneous fistula after urethroplasty,which was succesfully repaired 8 month later;16 cases were followed up average 24 months (range 7 months to 57 months),15 cases showed complete straight penis beside one case with mild curvature less than 15 degree. Conclusions The abnormalities of skin,dartos and Buck's fasciae are main causes of congenital islated penile curvature.Penile degloving,dorsal plication are main surgical methods with minimal complications.
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After pelvic trauma, complications of urethral stricture and organic impotence may develop. Certain cases of these are combined with penile curvature, which treatment method of artificial erection alone is not suitable, because severe penile pain may occur during erection, Therefore proper surgical methods should be added for straightening the penile curvature. After pelvic trauma, complete urethral stricture and organic impotence with penile curvature developed in 3 patients who complained severe pain due to curvature during the intracavernosal injection test. To all, treatment of choice for complete urethral sticture was visual internal urethrotomy for prevention of further development of curvature, and for curvature, Nesbit's penile straightening operations were performed, one by one. All patients could well urinate and enjoy their sexual intercourse after intracavernosal injection of PGE1 or papaverine. We recommend visual internal urethrotomy and the Nesbit's operation as effective methods to treat the case of penile curvature combined with complete urethral stricture after pelvic trauma.
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Humans , Male , Alprostadil , Coitus , Erectile Dysfunction , Papaverine , Urethral StrictureABSTRACT
Congenital penile curvature without chordee is a rare anomaly and a surgically correctable lesion which can usually distinguished from chordee and other acquired causes of penile curvature. The lesion is usually found in young men in the third decade of life. The curvature is usually present since birth but there are no complaints until puberty. Physical examination with the penis in the flaccid state is usually normal. We report a case of ventral curvature of the penis in 20-year-old-male. Correction of the penile curvature with Nesbit`s operation was Performed.