The effectiveness of penile curvature treatment by cavernous body rotation and plication of the tunica albuginea

Background

There are several approaches to the surgical treatment of the penile curvature conditionally divided into three large groups: tunica albuginea plication (TAP), corpus cavernosum rotation (CR), and transplantation of various materials. The study aims to compare the effectiveness of TAP and CR techniques in the treatment of penile curvature. There was a prospective randomized study of the effectiveness of surgical treatment of patients with an established diagnosis of the penile curvature from 2017 to 2020 in Irkutsk, Russian Federation. The final analysis of the results included 22 cases.

Results

The analysis of the comparative intergroup effectiveness of the treatment performed based on the criteria established in the study showed good treatment results in 8 (88.8%) patients in the CR group and 9 (69.2%) patients in the TAP group (p = 0.577). The other patients obtained satisfactory results. There were no negative outcomes. Simple logistic regression analysis showed that the preoperative flexion angle > 60 degrees (OR 2.7; 95% CI 0.12; 5.28; p = 0.040) was significant in predicting the complaints of penile shortening during TAP. Both methods are safe, effective, and bring minimal risk of complications.

Conclusion

Thus, the effectiveness of both treatment methods is comparable. However, TAP surgery is not recommended for patients with an initial curvature of more than 60 degrees.

Plication techniques in Peyronie's disease: new developments

To date, surgical correction remains the gold standard for patients with stable Peyronie's disease (PD) due to its high efficacy and low morbidity. Among the surgical procedures, penile plication (PP) can be offered to men who have adequate erectile function and penile length (>13 cm), with a curvature <60° and a predicted shortening of maximum 20% of the penis. The aim of this paper is to review the new developments that have emerged in the last years about the use of PP in patients with PD. A nonsystematic review of the literature was carried out searching in the PubMed and EMBASE databases from January 01, 2009 to April 01, 2019 including the words 'Peyronie', 'penile curvature', 'penile induration', 'plication', and 'plicature'. New developments in PP in the last 10 years include avoiding degloving by using a penoscrotal incision, a new mathematical model to predict loss of length after PP, a wider range of indications including patients with severe (≥60°) or complex curvatures, burying knots to avoid later discomfort, and thinning or incising the plaque to prevent excessive shortening. PP is a well-founded procedure with great results in appropriately selected patients. Given the lack of any prospective randomized trial, no clear recommendation can be made of one technique over another.