Graftless penile correction: Excellent outcomes

Orlando, FL-Correcting congenital penile curvature with excision and plicating closure of the tunica albuginea without grafting leads to excellent outcomes, according to a study from the Eastern Virginia Medical School, Norfolk, VA, presented at the 2008 AUA annual meeting here.

One reason satisfaction with the completed procedure is high among these patients is that penile length in congenital curvature is not as great a concern as it appears to be among patients with Peyronie's disease, first author Timothy O. Davies, MD, told Urology Times.

"Congenital curvature is a common presentation among patients with curvature," said Dr. Davies, a fellow in reconstructive urology working with Gerald H. Jordan, MD, and colleagues. "We wanted to isolate those patients with type 4 curvature, which is generally described as an asymmetric compliance of the tunica albuginea, as opposed to types 1 to 3, which are typically referred to as chordee without hypospadias. The interesting thing about this subgroup is that most have normal, or even enlarged erections, so length is not typically a concern with them.

To arrive at these observations, Dr. Davies and his colleagues conducted a retrospective chart review of patients undergoing corrective procedures at Eastern Virginia Medical School between 1990 and 2007. Those with an abnormally placed meatus were excluded, as were those with stigmata of hypospadias whose meatus was normally placed.

Forty patients were available for study. Median age at the time of operation was 25, with three patients being younger than 17. Presentations included ventral curvature (26 patients), left curvature (eight patients), right curvature (one patient), dorsal curvature (four patients), and complex curvature (one patient). Curvatures ranged from 30 to 90 degrees (median, 45 degrees). Three patients had previous unsuccessful repairs, two with plications and one with dermal grafting. All patients were found to have normal erections on ultrasound or sleep studies.

Excision and plicating closure of the tunica albuginea was performed in 37 patients. The remaining three underwent another form of corporoplasty. Dr. Davies reported that the straightening procedure was successful in all patients, with no patient having a residual curve exceeding 10 degrees.

The principal surgeon conducting the series was Dr. Jordan, professor of urology at Eastern Virginia.

"There are many differing forms of plicating procedures. The excision and plication performed by Dr. Jordan is somewhat unique, but has the same principle of shortening the longer side of the curved penis as the other procedures," Dr. Davies explained.

Unique complication

There were no complications in the immediate postoperative period; however, three patients ruptured their suture lines.

"These patients are young men. They get firm erections, and three patients disrupted the plicating closure suture lines in the immediate postoperative period. They all had successful revision surgery. The rupture phenomenon is not isolated to our center," Dr. Davies said.

"Dr. Jordan has performed corrective procedures on several men who disrupted their sutures after having plicating procedures done elsewhere. We are now much more aggressive in making sure that we suppress their erections as much as possible in the immediate postoperative time frame."

Dr. Davies explained that a regimen of amyl nitrate and valium for a minimum of 3 to 6 weeks after surgery was used to prevent reinjury.

Many of these patients with type 4 curvature benefit from sexual counseling prior to scheduling surgery, he added.

"It is noteworthy that none of these patients was treated with a graft. Grafting the corpora cavernosa in any patient raises the potential of graft-induced erectile dysfunction, which can be a catastrophic consequence in these young patients," Dr. Davies concluded.