One Stage Correction of Congenital Complex Penile Curvature by Combined Modified Nesbit's Procedure With Dorsal Dartos Flap

Abstract

Background: Congenital complex penile curvature (CCPC) is a rare deformity that arises from asymmetry of the corpora cavernosa. Congenital complex penile curvature has two abnormality components: torsion and curvature of the penis either ventral or dorsal.Objectives: Evaluation of one stage correction of CCPC by combination of modified Nesbit's procedure with dorsal dartos flap.Patients and Methods: This prospective study was conducted at Al-Azhar University Hospital in Damietta. Twenty eight patients with CCPC were evaluated and corrected during the period from October 2014 to September 2017. Their mean age was 5.5±2.1years (range 2-9.5 y). The direction of mal-rotation was anticlockwise in 23 patients and clockwise in 5 patients. Fifteen cases have ventral curvature; 8cases have dorsal curvature, while 5 cases have lateral curvature. All cases were treated firstly by modified Nesbit's procedure for correction of chordee, and then dorsal dartos flap was used for correction of penile mal-rotation in one stage.Results: All patients were corrected with high success rate. There were no more than 10° of residual malrotation or binding in all patients. One patient (3.57%) had penile hematoma that treated conservatively. All patients and their parents were satisfied with wonderful cosmetic and functional outcomes with no recurrent mal-rotation or binding. All cases were followed up for a mean follow up period of 9 ± 1.7 months (range 6 -12 m.). Conclusion:Congenital complex penile curvature can be treated in one-stage surgery with excellent cosmetic and functional outcomes by combination of modified Nesbit's procedure with dorsal dartos flap.

Update in management of Congenital Penile Curvature complex .

“…Congenital complex curvature of the penis is a relatively infrequent condition that combines two deformities: torsion and curvature of the shaft of the penis [7,8] . The clinical presentation of CPCC varies depending on the degree of curvature/torsion and its functional and psychological consequences.…”

“…Several surgical procedures have been described for correcting either congenital curvature or torsion of the penis. However, a few studies addressed the treatment of CPCC particularly in single-set surgery [8] .…”

“…As discussed above, there are several studies on the correction of congenital penile curvature or torsion in isolation. However, a few reports have addressed the one-stage surgery in the management of CPCC [8] . Belgrano et al [22] illustrated an asymmetrical, racket-shape tunica albuginea excision in the management of CPCC using two different sizes of Allis clamps on the longer portion of the tunica albuginea to delineate the maximum area for excision.…”