Trans-Scrotal Penile Degloving, a New Procedure for Corporoplasties

Austoni, E.; Altieri, Vincenzo; Tenaglia, R.

doi:10.5301/ru.2012.9211

Cited by 9 publications

(5 citation statements)

References 22 publications

(15 reference statements)

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“…There are reports describing circumferential lymphoedema of this sleeve in operations involving penile degloving, possibly as a consequence of severing of its lymphatic continuity with the skin of the shaft [13]. We have indeed observed a similar situation after conventional frenulum-dividing circumcision as well, leading to a persistent woody ring around the corona that mars cosmesis.…”

Section: Discussionsupporting

confidence: 53%

Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

Shenoy

Marla

Sharma

et al. 2015

JCDR

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Section: Discussionsupporting

confidence: 53%

Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

Shenoy

Marla

Sharma

et al. 2015

JCDR

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“…Despite widespread adoption, the circumcising incision has a number of drawbacks. Complications can include penile lymphedema, decrease in glans sensitivity, paraphimosis, distal skin necrosis, and excess postoperative pain [10] . Given that the goal of PIEG is good functional and cosmetic outcomes, any one of these issues can be debilitating in the PD patient.…”

Section: Discussionmentioning

confidence: 99%

Excision and Patch Grafting of a Lateral Peyronie's Plaque—Utilizing a Longitudinal “Window” Approach

Lue¹,

Emtage²,

Martinez³

et al. 2015

Sexual Medicine

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IntroductionPeyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used.AimsThe aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time.MethodsA patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting.Main Outcome MeasuresThe main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair.ResultsThe plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature.ConclusionA lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.

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“…Austoni's technique was used to deglove the penis and isolate the neurovascular bundle 11 . We used the iGraft app as previously described to correct the penile curvature using PIG.…”

Section: Methodsmentioning

confidence: 99%

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

Miranda

Sampaio

2016

Sexual Medicine

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IntroductionPenile curvature correction with plaque incision and graft (PIG) increases the risk of erectile dysfunction (ED) and is associated with mechanical and geometric abnormalities.AimsThe aim of this study was to create and validate a new PIG technique using minimum graft area to correct simple or complex penile curvature with or without hourglass deformity, while avoiding mechanical and geometric abnormalities.MethodsUsing our cotton fabric model, we created a mathematic solution for PIG with no residual defects. This was applied in nine men who had sufficient penile rigidity while penetrating their respective partners. They underwent fascia lata patch corporoplasty using the new developed technique (iPad [Apple Corp, Palo Alto, CA, USA] app: iGrafter). Subjects answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire preoperatively and at the end of follow-up.Main Outcome MeasuresThe main outcome measures used were patient demographics, erectile function, residual curvature, patient satisfaction, graft area, and complications.ResultsAfter a mean follow-up of 17.8 months, no significant complication was noted. Complete penile straightening was achieved in all patients. The short side of the penis increased a mean of 3 cm in length, and the mean graft area was 12.4 cm2. At the end of the follow-up, three patients developed recurrent deformity. One patient presented severe fibrosis in the corpora cavernosa and severe ED. There was no significant difference between the mean preoperative and postoperative IIEF-5 scores (20.6 vs 19.4, respectively). At the end of follow-up, all patients were able to have sexual intercourse (two with and seven without pharmacological aid). Eight of the nine patients were satisfied with the surgical result.ConclusionPenile curvature surgical correction using the iGrafter seems to be an efficient and safe procedure, which uses minimum graft area and preserves erectile function after penile rectification, without resulting in residual deformities. Further research is needed to confirm the efficacy of this procedure.

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Trans-Scrotal Penile Degloving, a New Procedure for Corporoplasties

Abstract: TPD, which represents an evolution of our previous combined subcoronal-trans-scrotal approach, may be advantageously performed in most corporoplasties with optimal aesthetic and functional outcomes, and may replace in many cases the subcoronal approach without its associated complications.

Cited by 9 publications

References 22 publications

Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

Excision and Patch Grafting of a Lateral Peyronie's Plaque—Utilizing a Longitudinal “Window” Approach

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease

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