Surgical treatment of Peyronie's disease by the intracavernosal plaque excision method: a new surgical technique.

OBJECTIVE: A new surgical method of treating Peyronie's disease consisting in intracavernosal excision of the plaque is presented. MATERIAL AND METHODS: The operation was performed on 16 men aged from 34 to 65 years (mean 50.2 years). The angle of penile curvature was 30 degrees to 60 degrees. Thirteen (81.25%) had impaired intercourse because of penile deformity and in 3 (18.75%) patients it was prevented by marked penile curvature. The mean quality of life score (QoL) was evaluated as 4.8. The operation consists in incising the corpus cavernosum parallel to the plaque and through this incision removing the plaque from the inside without incising or replacing the underlaying tunica albuginea. RESULTS: Follow-up examinations made after 3, 6 and 12 months revealed normal, painless erection in all the patients. In 2 (12.5%) intercourse was impaired only by persistent penile curvature of over 20 degrees. Mean QoL score -1.1. CONCLUSIONS: In our opinion intracavernosal plaque excision is a simple method, easier to perform and less invasive than the operative methods applied to date. It eliminates the pain, does not result in a shortening of the penis, loss of sensation or erectile dysfunction. It ensures a considerable improvement in the QoL of the patients treated.

Microsurgical replantation of sexual organs in three patients.

OBJECTIVE: The present study deals with microsurgical replantation technique. MATERIAL AND METHODS: The technique was applied in 3 patients whose sexual organs had been accidentally cut off. RESULTS: Necrosis of the sutured organs occurred in 2 cases. In 1 case, however, healing with proper miction and sexual function was achieved. Prolonged period (over 12 hours) from the accident to operation as well as the extensive injury of tissues with the vascular system crush were considered to be the main reason for failure. CONCLUSIONS: Microsurgical reconstruction of penis and testes with the use of vessel grafts prolonged the hypoxia which led to necrosis. Disturbances in vein blood outflow from the sutured organs contributed to this process as well. The third case resulted in success mostly due to quick intervention (5 h from injury) as well as to proper microsurgical reconstruction of vessels, nerves, and urethra. In addition suprapubic urine diversion was successfully applied and the urethra healed on the perforated catheter. Routine antibiotics as well as antithrombotic prophylactics were administered in all of the 3 cases.

Ultrastructure of the tunica albuginea in congenital penile curvature.

PURPOSE: We investigated the ultrastructure of the tunica albuginea in individuals with congenital penile curvature to explain the pathology of this disease. MATERIALS AND METHODS: Included in our study were 15 patients 17 to 24 years old with congenital penile curvature. Study material consisted of samples of the tunica albuginea excised from the greater curvature of the corpus cavernosum during surgical correction. Control samples were obtained from the lesser curvature on the side opposite the study material during the same operation. The 2 types of tissue were analyzed using transmitter electron microscopy. RESULTS: Ultrastructural examination of the control material revealed numerous collagen fibers that were homogenous in size and organization on cross section. Periodic striation was typical in collagen that produced fibers. In the study group the tunica albuginea structure had a chaotic pattern of collagen fibers that formed bundles with disrupted 3-dimensional organization. Diameter of the fibers differed greatly on cross section. We observed periodic widening and fragmentation of collagen fibers with the complete disappearance of striation and transformation into electron dense, fibrous granulated material. Disrupted fibroblasts without cell membrane and cellular organelles between collagen fibers were also visible. There was elastin accumulation without any morphological differences in the control and study groups. CONCLUSIONS: Our results show that ultrastructural changes in the tunica albuginea may cause congenital penile curvature, possibly by altering mechanical properties.

Successful microsurgical replantation of an amputated penis.

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury.

Microsurgical replantation of the amputated penis and scrotum in a 29-year-old man.

A 29-year-old mentally ill farmer underwent microsurgery for the resuturing of the penis and testicles which he himself had chopped off with an ax. Microsurgery of the urethra, corpora cavernosa, arteries and veins was begun 10 h after the trauma. The veins, arteries and testicles were anastomosed and covered with a free flap of the scrotum skin. Three weeks after surgery, the anastomosed tested showed good healing. However, in 65% of the penis, necrosis had occurred.

[Autotransplantation of the testis as a method of cryptorchism treatment]. / Autotransplantation des Hodens als Behandlungsmethode des Kryptorchismus.

Four patients at the age of 20-55 years treated for cryptorchism by means of microvascular anastomosis were presented. Considerable usefulness of autotransplantation was revealed on the basis of 5 procedures performed, especially in the case of intra-abdominal location of the testes.