Penile curvature: an update for management from 20 years experience in a high volume centre

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.

The factors that cause penile shortening after plication surgery in patients with congenital penile curvature: [[es]]Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita

OBJECTIVE

Congenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology. We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature.

METHODS

Between November 2010 and December 2020, we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery. Before the procedure, patients' age, curvature location and degrees, as well as penile length were recorded. After the treatment, penile lengths were measured and recorded again. Early and late period results were recorded.

RESULTS

Plication surgery was performed in 130 patients. The median age was 24 years. Seventy-six patients had ventral curvature, 22 had dorsal curvature, 32 had lateral curvature. Average shortening of penile length in patients with curvature below 30° was: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. Patients with curvatures above 30° were: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm.

CONCLUSION

Penile length shortening after plication is inevitable. Curvature degree and direction are factors affecting penile length after surgery. Therefore, patients and relatives should be informed in more detail about this complication.

Clinical and penile Doppler outcomes using a modified, tourniquet free, Nesbit plication for severe Peyronie's disease

Background

Penile curvature (PC) can be surgically corrected by plication techniques or Nesbit corporoplasty. These shortening techniques can be complicated by post-operative: penile shortening, recurrent PC, palpable suture knots and erectile dysfunction. Furthermore, Nesbit procedures require the use of a penile tourniquet to avoid intraoperative bleeding. This observational study aims to assess the results of Nesbit modified corporoplasty, avoiding intraoperative use of tourniquet without risk of bleeding. The objective is to reduce penile ischemic anatomical and functional damages such as long-term erectile dysfunction.

Methods

Between January 2010 and March 2019, a total of 64 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent surgical correction with a Nesbit modified technique first time described by Rolle et al., with minimal technical differences. The operation notes were retrospectively reviewed. In particular, we evaluated pre- and post-operative erectile functions using IIEF-5 score, penile Doppler ultrasonography and overall patient satisfaction.

Results

During operations, no intraoperative bleeding was noted, and no short-term complications such as hematomas or neurovascular bundle lesions were reported. At 6 months, no palpable subcutaneous indurations and no sensory change were detected. Post-operative penile shortening was reported in 38 (59.4%) patients (mean 0.83±0.79 cm), but it did not influence the high overall satisfaction rate of 91.4%. Only 2 patients reported a slightly partial recurrence of curvature (<15%) with no need for a redo surgery. Mean IIEF-5 score increased from 17.1±5.2 to 20.8±3.9 at 6 months and 21.8±3.4 at 12 months (P<0.001 in both cases). Mean PSV also significantly increased at the end of follow-up (28.5±6.1 at baseline vs. 31.0±7.1 at 12 months, P=0.03).

Conclusions

Considering the optimal results in terms of erectile functions increasing and absence of PC recurrence (>15°), we think that Nesbit modified corporoplasty without tourniquet application during reconstruction is a safe and effective surgical procedure for all kind of shortening corporoplasty to reduce the time of penile ischemia, preventing even serious consequences for the normal physiology of erection.

Is social media reliable as a source of information on Peyronie's disease treatment?

Although YouTube video is one of the most widely used and easily accessible information sharing sources, its widespread use can carry the risk of spreading misleading and unreliable information. We aimed to evaluate the accuracy, reliability, quality, and content of the most viewed YouTube videos related to Peyronie's disease treatment. The keywords of "penile curvature", "penile deformity", "bent penis" "curved penis", and "Peyronie's disease" were searched on YouTube. Among 700 YouTube videos, 267 videos were included in the study. They were categorized by two independent urologists with board certification as accurate information (n = 138, 51.7%) or inaccurate information (n = 129, 48.3%). Accurate videos contained information about the treatment of Peyronie's disease with proven scientific accuracy according to the current guidelines, whereas inaccurate videos contained scientifically unproven or incorrect information and recommendations not in the guidelines. A 5-point modified DISCERN scale and Global Quality Score were used for reliability and quality assessment. Although the accurate information group had a significantly higher DISCERN Score (3, IQR = 3-4 vs. 1, IQR = 1-2, p < .001) and Global Quality Score (5, IQR = 4-5 vs. 2, IQR = 1-3 p < 0.001); the number of views per day (10.37, IQR = 3.01-28.12 vs. 6.65, IQR = 1.55-27.87) and likes (36, IQR = 6-145 vs. 19.5, IQR = 4-121.7) were higher but not significant in the inaccurate information group. The majority of the videos in the inaccurate information group were uploaded by medical advertisement/for profit companies (51.2%) and individual users/patients (38.8%), whereas universities/professional organizations/nonprofit physician/physician groups constituted the majority in the accurate information group (60.9%). According to our findings, videos containing inaccurate information are more popular. People should be made aware that they should not immediately believe the videos containing medical advertisements without consulting nonprofit physicians.