Operative correction of penile deviation with the Nesbit procedure and with Schroeder-Essed technique

Abstract

60 patients with a marked penile deviation [40 because of a congenital penile deviation (CPD) and 20 as a result of the Peyronie's disease] were questioned about the result of the operation by means of a questionnaire in a retrospective study with an average follow-up of 45 month. The Nesbit procedure had been used with 49 of these 60 patients, the modified Schroeder-Essed technique had been used with 11 patients. There were 15 patients (25%) in all, who suffered a relapse. In spite of the continual use of non-absorbable suture material with the Schroeder-Essed technique, the number of relapses was in this group plainly higher than in the Nesbit group (55% and 18% respectively). In our opinion this is caused by the insufficient tensile strength of pure plications. Regardless of the operating method, patients suffering from IPP showed a higher number of relapses than patients having a CPD (35% and 20% respectively). The reason for this might be the fact that one can never rule out completely the possibility of a further progress of the disease. 71% of the patients in the Nesbit group were satisfied with the results of the operation, in the Schroeder-Essed group there were only 36%. Irrespective of the operating method, IPP patients complained moreoften about late complications and erection problems after the operation and were more rarely satisfied with the result than patients with a CPD (50% and 73% respectively). We put this down to the fact that patients with a CPD and patients suffering from IPP represent very different collectives as far as age structure and morbidity are concerned. IPP patients frequently have erection problems even before the operation. Especially with IPP patients, preoperative erectile disfunction must be excluded, in the case of their occurrence there are to prefer other programmes of therapy.

Long-term results with Nesbit's procedure as treatment of Peyronie's disease

“…On the other hand, a high incidence of recurrence of the deformity is reported when absorbable sutures are used. 20 Typically these patients reported good initial results but with subsequent recurrence after few months. Probably Long-term results with Nesbit's procedure G Savoca et al the stitches can not withstand the traction during repeated erections in the early postoperative period.…”

“…Residual curvature inferior to 20 degrees was seen postoperatively in 24 patients (15.3%), whereas in two patients (1.3%) it was 25 degrees. Over-correction (20 ) occurred in only one patient (0.6%). The residual curvature doesn't prevent intercourse in any patient.…”

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

“…In a study comparing plication and the lateral Nesbit technique, there was a significant difference in penile hyposensitivity, with rates of 38% and 75%, respectively 14. The rate of recurrence reported for the Nesbit procedure was much lower than the plication rate reported in comparative studies (0%–18% vs 16%–55%) 1415…”

Tunical plication in the management of penile curvature due La Peyronie’s disease. Our experience on 47 cases

“…The optimal surgical treatment for PD is still debatable [23,24]. The Essed-Schroeder procedure with plication of the tunica albuginea may result in palpable plication nodes with patient discomfort [25]. It can be decreased by using the inverting stitch technique or by varying the suture material [26,27].…”

“…Patients with painless PD plaque with no progression in angulations for at least 12 months were chosen for surgery. Preoperatively penile curvature was greater than 30 degrees in all patients, as documented by auto-photography using the Kelami technique [12]. Several self-administered patient questionnaires assist in the evaluation of sexual function.…”