Geometrical modified nesbit corporoplasty to correct different types of penile curvature: description of the surgical procedure based on geometrical principles and long-term results

Abstract

We present the use of a modified corporoplasty, based on geometrical principles, to determine the exact site for the incision in the tunica or plaque and the exact amount of albuginea for overlaying to correct with extreme precision the different types of congenital or acquired penile curvature due to Peyronie's disease. To describe our experience with a new surgical procedure for the enhancement of penile curvature avoiding any overcorrection or undercorrection. Between March 2004 and April 2013, a total of 74 patients underwent the geometrical modified corporoplasty. All patients had congenital curvature until 90° or acquired stable penile curvature 'less' than 60°, that made sexual intercourse very difficult or impossible, normal erectile function, absence of hourglass or hinge effect. Preoperative testing included a physical examination, 3 photographs (frontal, dorsal and lateral) of penis during erection, a 10 mcg PGE1-induced erection and Doppler ultrasound, administration of the International Index of Erectile Function (IIEF-15) questionnaire. A follow-up with postoperative evaluation at 12 weeks, 12 and 24 months, included the same preoperative testing. Satisfaction rates were better assessed with the use of validated questionnaire such as the International Erectile Dysfunction Inventory of the Treatment Satisfaction (EDITS). Statistical analysis with Student's t-test was performed using commercially available, personal computer software. A total of 25 patients had congenital penile curvature with a mean deviation of 46.8° (range 40-90), another 49 patients had Peyronie's disease with a mean deviation of 58.4 (range 45-60). No major complications were reported. Postoperative correction of the curvature was achieved in all patients (100%). Neither undercorrection nor overcorrection were recorded. No significant relapse (curvature>15°) occurred in our patients. Shortening of the penis was reported by 74% but did not influence the high overall satisfaction of 92% (patients completely satisfied with their sexual life). The erectile function was analyzed in both groups, Student's t-test showed a significant improvement in erectile function, preoperative average IIEF-15 scores were 17.43±4.67, whereas postoperatively it was 22.57±4.83 (P=0.001). This geometrical modified Nesbit corporoplasty is a valid therapy which allows penile straightening. The geometric principles make the technique reproducible in multicentre studies.

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

“…Results of group 2 were comparable to other study that used the 16-dot technique ( 11 ). Furthermore, the correction of penile curvature, residual curvature and recurrences, using the new technique, was comparable to another study that used corporoplasty ( 19 ).…”

“…On the contrary, tunical plication procedures are less invasive ( 15 – 17 ) and separation of dorsal neuro-vascular bundles from the tunica albuginea is not done in 16 dot plication technique ( 11 , 18 ). However, in plication, the strength depends only on the sutures and not on the healing process ( 11 , 17 , 19 , 20 ). After tunical plication, the recurrences rates were high ( 10 , 16 , 19 ) and the presence of permanent palpable knots at the site of the tunical sutures ( 15 , 21 ) was noted causing discomfort or even pain ( 11 , 22 , 23 ).…”

“…However, in plication, the strength depends only on the sutures and not on the healing process ( 11 , 17 , 19 , 20 ). After tunical plication, the recurrences rates were high ( 10 , 16 , 19 ) and the presence of permanent palpable knots at the site of the tunical sutures ( 15 , 21 ) was noted causing discomfort or even pain ( 11 , 22 , 23 ). Furthermore, creation of a protruding bulk inside the cavernous cavity decreases its volume and compresses cavernosal tissue ( 23 ) and excessive folding may also lead to decreased distal rigidity ( 24 ).…”

Peyronie’s disease – outcomes of collagenaseclostridium histolyticuminjection: A systematic review

“…The most effective way to combat the disease is by surgical intervention. Tunical plication, grafting, and penile prosthesis implantation are the most invasive procedures performed to alleviate penile curvature; these involve open procedures that allow surgeons to manually straighten the penis via three different methods [ 4 , 18 , 19 ]. The other, and less aggressive option involves intralesional (IL) injection directly into the plaque in hope to eradicate PD symptoms.…”

Nesbit yöntemi ile tedavi edilen konjenital penil kurvatür hastalarında uzun dönem sonuçları

“…Penil kurvatür, hastaların cinsel yaşamıyla başlayıp zaman içerisinde psikolojik faktörlerle birleşerek tüm hayatını etkileyen bir sağlık sorunudur. Konjenital veya edinsel birçok nedene bağlı olarak görülebilmektedir 1 . Konjenital penil kurvatür (KPK) üretral malformasyon olmaksızın korpora kavernozadaki tunika albugineanın embriyogenez sırasında asimetrik olarak gelişim eksikliği ile meydana gelen en sık konjenital sebeptir 2 .…”