A new technique, combined plication-incision (CPI), for correction of penile curvature

ABSTRACT Introduction Penile curvature (PC) can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction. Objective To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI). Materials and Methods Two groups (1&2) were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot technique. In each group of 4 dots the superficial layer of tunica albuginea was transversely incised (3-6mm) at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot. Results Twelve (57.1 %) participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005). Postoperative shortening (5mm) of erect penis, encountered in 9 participants, was doubled in group 2 but with insignificant difference (P>0.05). Post-operative recurrence of PC, was encountered in only 1 (4.8%) participant in group 2, compared to none in group 1, with insignificant difference (P>0.05). Post-operative erectile rigidity was normally maintained in all participants. Conclusion The new technique was superior to the 16-dot technique for correction of PC.

Enfermedad de La Peyronié, un trastorno infradiagnosticado / La Peyronié´s disease, an infra-diagnosed disorder

La enfermedad de La Peyronie es una entidad patológica descrita por primera vez en 1743, por François Gigot de la Peyronie, que se manifiesta como una induración en la albugínea de los cuerpos cavernosos del pene. Es un reconocido problema que afecta a los hombres de la mediana edad. En estudios realizados se constata que su incidencia real es muy superior a la del diagnóstico. Su sintomatología consiste en la incurvación del pene durante la erección, dolor y pobre consistencia en la zona de incurvación. Debido al infradiagnóstico de esta patología y la repercusión que tiene para el paciente, se decide realizar la presentación de un caso de enfermedad de La Peyronié. Paciente ACS con 25 años de edad, blanco, que acude a consulta por dolor y aumento de volumen de la porción proximal del pene, acompañado de un cuadro depresivo, con antecedente familiar de madre con enfermedad de Ledderhose. El ultrasonido del pene mostró múltiples placas de fibrosis, el resto de los complementarios sin alteración. Se hace necesaria la divulgación de la enfermedad para la realización de un diagnóstico y tratamiento oportuno (AU).

La Peyronié´s disease is a pathological entity firstly described in 1743, by François Gigot de la Peyronie, presented as an induration in the albuginia of the cavernous body of the penis. It is a recognized problem affecting middle-aged men. In carried-out studies it is stated that its real incidence is much higher than the diagnostic incidence. The symptoms are penis curvature during the erection, pain and poor consistence in the zone of the curvature. Due to this disease's infra-diagnosis and the repercussion it has for the patient, we decided to present a case of La Peyronie´s disease. ACS patient, aged 25 years, white, assisting the consultation because of a pain and a volume increase of the penis proximal portion, accompanied by depression, and family antecedents of mother with Ledderhose´s disease. The penis ultrasound imaging showed fibrosis plaques; the rest of the complementary tests showed no alterations. It is necessary to popularize this disease for its opportune diagnosis and treatment (AU).

Penile corporoplasty with Yachia's technique for Peyronie's disease: Single center experience with 117 patients

Peyronie's disease is an acquired penile deformity with a variety of presentations, caused by the formation of fibrous plaques within the tunica albuginea, leading to bio-mechanical and vascular abnormalities. The objective is to investigate the 18 years outcome of patients with Peyronie's disease treated with penile corporoplasty [Yachia technique] in our department. One hundred and seventeen patients underwent surgical treatment for PD between 1991 and 2009 and were retrospectively evaluated. We used the Levine and Lenting's algorithm for surgical treatment. Data was obtained from medical records, clinical evaluation, and telephone interview. Post-operative follow-up was at 6 weeks and 12 months. The mean time of follow-up was 14 months [12-19 months]. Patient demographic, co-morbidities, erectile function, penile curvature, and surgical intervention were documented. The main outcome measures of this study are postoperative complications, surgical purpose, and patients and partner's satisfaction rates. Surgical aim was obtained in 106 patients [success rate of 94.6%]. Complications occurred in 4.5% of patients, but most of these were mild. At 6 weeks, complete straightening of the penis was achieved in 57 patients [50.9%], and partial straightening which allow sexual intercourse in 49 patients [43.7%]. Nine patients report gland hypoesthesia and almost all report subjective perception of penis shortening [0.5 cm to 5 cm]. Twenty-two patients developed recurrent deformity at 12 months follow-up, with compromise of sexual intercourse in 7 patients. Patients' responses to our questionnaire showed that overall 88.4% of the patients and partners were satisfied with the surgical results. According to the results of this long-term, retrospective study, surgical correction, using the Yachia technique, is an excellent option for patients with functional impairment from their Peyronie's disease, especially.

Disfunción eréctil en población masculina mayor de 35 años en la ciudad de Siguatepeque / Erectile dysfunction in men above 35 in Siguatepeque, Honduras

Las funciones sexuales y eréctiles son importantes en la salud de los hombres y el bienestar de las parejas. La disfunción eréctil (DE) tiene una alta prevalencia fundamentalmente en las últimas décadas de la vida y se halla relacionada con múltiples factores de riesgo. Objetivo: establecer algunos factores de riesgo y enfermedades concomitantes así como la prevalencia de la disfunción eréctil en la población masculina mayor de 35 años de la ciudad de Siguatepeque, Honduras, agosto del 2009. Metodología; estudio descriptivo de corte transversal. La población fue de 5,200 hombres mayores de 35 años. La muestra de 371 hombres. El método de muestreo fue estratificado según barrios de la ciudad. La unidad de estudio fue seleccionada en forma aleatoria. Para la recolección de datos se utilizaron dos instrumentos, una encuesta con datos de carácter general; otro instrumento utilizado fue el Test de SHIM (Sexual Health Inventory for Men), cuestionario sobre salud sexual masculina, versión abreviada del IIEF (Índice Internacional de Función Eréctil) del que se seleccionaron 5 preguntas sobre sexualidad masculina en los últimos 6 meses, con el propósito de detectar DE en grupos de riesgo. Se considera DE cuando la puntuación es igual o inferior a 21. Resultados; La prevalencia de DE encontrada fue de 214(58%) del total de la muestra, los grados de disfunción fueron: Leve 114(53%), de Leve a Moderada 57(27%), Moderada 18(8%), y Grave 25(12%). La DE encontrada según rangos de edad fue para mayores de 60 años 94(44%), de 45 a 59 años 95(45%), de 35 a 44 años 25(11%). Los hábitos tóxicos: hombres que en el pasado ingirieron bebidas alcohólicas y al momento de la entrevista consumían y tenían DE 104(49%) y 50(23%) respectivamente. Tabaquismo como antecedente de consumo y al momento de la entrevista presentaban DE, 96(45%) y 55(26%) respectivamente. El consumo de otras drogas 3(1%). Las enfermedades concomitantes que se relacionan con DE fueron: problemas cardiovascular...

Small intestinal submucosa for patch grafting after plaque incision in the treatment of Peyronie's disease

OBJECTIVE: Report the results using porcine small intestinal submucosa (SIS) as a graft material in the surgical management of Peyronie's disease (PD). MATERIALS AND METHODS: We performed a retrospective chart review of men with PD who underwent surgical correction of the curvature by plaque “H” incision and patch grafting with 4-ply SIS (Cook, Bloomington, IN) by a single surgeon at our institution. Degree and direction of curvature, sexual function, and co-morbidities were assessed pre- and postoperatively. RESULTS: Thirteen patients were identified. Mean age was 57 ± 8, range 42-70 years. Median follow-up was 14 months, range 3-89 months. At presentation, all reported penile curvature. Also reported were difficulty with vaginal penetration (determined by question number 2 of the sexual encounter profile questionnaire - SEP2), palpable plaque, hourglass deformity, difficulty with firmness, and difficulty with sustaining erection (determined by SEP3) in77 percent, 69 percent, 77 percent, 62 percent, and 46 percent of patients, respectively. Mean and median degrees of curvature of the primary deformity were 71 and 67.5 degrees, respectively. Three patients had secondary curves of less than 30 degrees in a different direction. Mean and median plaque size were 3.5 and 2.7 cm², respectively. Seven patients had one graft and six patients had two grafts placed with a mean size of 15 ± 0 cm². CONCLUSIONS: For the patient with PD, SIS grafting can achieve a functionally straight erection with durable results yet with relatively high rates of erectile dysfunction. SIS is a viable graft material for use in the surgical treatment of PD.

Disfunción erectil I: epidemiología, factores de riesgo y principales causas / Erectil dysfunction I: epidemiology, risk factors and main causes

Se entiende por disfunción eréctil (DE) la incapacidad de alcanzar y mantener una erección de suficiente rigidez para un desempeño sexual satisfactorio. Esta definición, emitida por el panel de expertos en la conferencia de consenso para la impotencia del Instituto Nacional de Salud (INS) de los Estados Unidos de 1992 (1,2), reemplaza el término Impotencia por el de disfunción eréctil, que es expresión más precisa y de menor connotación cultural. Asimismo, se recomienda caracterizar la DE de acuerdo a su etiología, como disfunción eréctil vasculogénica, sicogénica, hormonal, neurogénica, etc.

Impotence with intractable Peyronies disease

Eleven patients with organic impotence associated with resistant Peyronie's plaques were scheduled for combined treatment of both condition at the same session. The plaques were incised together with insertion of semirigid penile prosthesis [AMS 600]. This technique resulted in correction of the penile deformity and a satisfactory sexual performance in all patients. Postoperative complications were not encountered except of mild local pain which persisted for few weeks postoperative. This procedure proved to be simple and effective, however should be performed on carefully selected patients