Excision of elliptic fragment of external layer of tunica albuginea as an element of a new,
low-invasive method of operative treatment of congenital penile curvature
Article published in Urologia Polska 2008/61/Supl. 1.
Wojciech Perdzyński, Marek Adamek
- Zespół Chirurgii Rekonstrukcyjnej Męskich Narządów Moczowo-Płciowych, Szpital Damiana w Warszawie
Introduction. The methods used till now in treatment of congenital penile curvature have many disadvantages. After operations done by Essed-Schroeder method many recurrences (15-20%) appear which are caused mainly by slow cutting of tunica albuginea by the sutures. During operations done by Nesbit (excision of a full thickness fragment of tunica albuginea) or Yachia (incision of the tunica albuginea) methods corpora cavernosa are opened and superficially situated cavernous sinuses are injured which lead to intraoperative bleeding. That is why in operations by these methods are done usually in ischemia which in turn may be the reason for damage of erectile and sensory nerves as well as damage of erectile tissue.
Objectives. The aim was presentation of results of operative treatment of congenital penile curvature by a new, low-invasive method.
Material and methods. From 2006 to 2007 authors operated on by new method 28 patients: 24 adult men aged from 18 to 63 years (average 26.6 years) and 4 boys aged from 6 to 15 years (average 9.7 years) with congenital penile curvature. In 3 patients with associated hypospadias after reconstruction of distal urethra and in 4 patients after closing urethro-cutaneous fistulas which complicated previous operations for hypospadias done elsewhere at the same procedure penis was straightened.
- Among 21 patients operated for isolated penile curvature there were 3 patients in whom 2 operations (in each of them) by Essed-Schroeder method were done in other hospitals authors detected recurrence of curvature. Downward penile shaft curvature was detected in 19 patients (average angle 47 degrees), downward glans curvature in 4 patients, lateral penile curvature in 10 patients (average angle 43 degrees), upward penile shaft in 2, upward glans curvature in 2 patients. In 5 patients curvatures occurredat least in two planes (i.e. downward and lateral or upward and lateral). Skin and tunica dartos were incised longitudinally on convex surface of curvature (in patients with
- hypospadias after circumscision incision penis was degloved). Buck`s fascia was incised on lateral penis surface. After compressing a base of penis with a tourniquet artificial erection was produced by saline injection into cavernous body and the top of angle of curvature was marked. Operation of straightening was always done on penis in flaccid state, on its convex (longer) surface. In upward curvature dorsal neuro-vascular bundles were separated from the tunica albuginea and on dorsal penile surface bilaterally elliptic fragments of external layer of tunica albuginea were excised. Tunica albuginea were sutured with single absorbable sutures 2/0 or 3/0 which went through all thickness
- of tunica approximating the edges of its external layer and invaginating internal layer of tunica albuginea. In all patients straightening of penis was always checked by producing artificial erection. If curvature was still present next excisions of external layer of tunica with following sewing were done until penis was straight. In upward curvatures excisions were done on lower surface of penis on both sides of urethra. In lateral penile curvatures convex penile surface was shortened using above mentioned method.
Results. In all patients penis was straightened during operation. During follow-up examinations which were done from 6 to 18 months after operation all patients well assessed the shape of penis in state of erection, adult patients well assessed penile function during sexual intercourse. For confirmation that penis is straight authors also assessed photos made by patients during erection. Disorders of superficial feeling on the glans, erectile dysfunction or disturbances of micturition were not detected in any of patients.
Conclusions. 1. Excision of external layer of tunica albuginea and subsequent sewing of tunica with invagination of internal layer of tunica is effective method in the treatment of congenital penile curvature. 2. Operation is of little invasiveness because straightening of penis is done within the tunica albuginea, without the need for opening of cavernous bodies, which diminishes potential risk of complications. 3. For performing proposed operation knowledge of stratified structure of tunica albuginea
- is necessary as well as delicate and precise operative technique.