[Congenital penile deviation: an integral diagnostic approach to correction].

A comparative analysis of diagnostic examination of 130 men with isolated congenital erectile penile deviation (EPD) aged 14-22 years (mean age 17 years) has demonstrated that true EPD can be determined objectively only at adequate erection. Therefore, the diagnosis should be based not on subjective opinion of the patient but on the results of artificial pharmacological erection or viagra-test in combination with visual erotic and genital stimulation. Vacuum erection test is not justified. In patients with congenital EPD rigidity depends much on correlation between perfusion volume and functional volume of the penis (cavernous volume). The problem of congenital EPD can be formulated as the problem of "long penis". Measurements of the penis in the group of 54 patients with congenital EPD registered a low penile coefficient in 67% cases while a mean length of the penis in all the examinees was longer than a mean standard one and was about 13 cm in relaxed condition. EPD patients often suffer from asthenodepressive disorders deteriorating the copulative function. Psychotherapy and medication of the depressive syndrome result in stabilization of the psychological condition improving quality of life 1.3 times. Thus, an integrative diagnostic and therapeutic approach, due selection of the patients for operative correction of penile deviation can improve quality of the treatment aimed both at correction of erectile malformation and psychosexual adaptation of the patients.

[Choice of corporoplastic method in Peyronie's disease depending on hemodynamic status of the penis].

We studied 164 patients with Peyronie's disease, 34 of whom have clinical symptoms of erectile dysfunction. Dopplerography has detected alterations of penile hemodynamics in 71.8% cases. Vein occlusive dysfunction prevailed (54.8%). Dopplerographic signs of venoocclusive dysfunction were seen also in patients with minor erectile disorders (55.4%). The analysis of absolute values of the systolic velocity peak allowed us to consider values in the range > 25 but < 35 cm/s as borderline or suboptimal, corresponding to subclinical period of venoocclusive dysfunction. Dynamic cavernosometry results served the basis for criteria of subclinical venoocclusive dysfunction characterized by threshold intracavernous pressure 50 mm Hg, coefficient of 30-s reduction of intracavernous pressure from 1.75 +/- 0.93 to 2.1 +/- 0.8 mm Hg and supporting perfusion velocities under 29.2 +/- 15 ml/min. Characteristics of hemodynamic status and penile geometry help an optimal choice of deviation correction in patients with Peyronie's disease.