Congenital penile curvature with orthotopic meatus: a report on the management of 62 cases following a systematic approach
African Journal of Urology. 2003; 9 (4): 157-163
in En
| IMEMR
| ID: emr-205562
Responsible library:
EMRO
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 6.4% and 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
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 6.4% and 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
Search on Google
Index:
IMEMR
Language:
En
Journal:
African J. Urol.
Year:
2003