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Abstract
60 patients with a marked penile deviation [40 because of a congenital penile deviation (CPD) and 20 as a result of the Peyronie's disease] were questioned about the result of the operation by means of a questionnaire in a retrospective study with an average followup of 45 month. The Nesbit procedure had been used with 49 of these 60 patients, the modified Schroeder-Essed technique had been used with 11 patients. There were 15 patients (25%) in all, who suffered a relapse. In spite of the continual use of nonabsorbable suture material with the Schroeder-Essed technique, the number of relapses was in this group plainly higher than in the Nesbit group (55% and 18% respectively). In our opinion this is caused by the insufficient tensile strength of pure plications. Regard less of the operating method, patients suffering from IPP showed a higher number of relapses than patients having a CPD (35% and 20% respectively). The reason for this might be the fact that one can never rule out completely the possibility of a further progress of the disease. 71% of the patients in the Nesbit group were satisfied with the results of the operation, in the Schroeder-Essed group there were only 36%. Irrespective of the operating method, IPP patients complained more often about late complications and erection problems after the operation and were more ra rely satisfied with the result than patients with a CPD (50% and 73% respectively). We put this down to the fact that patients with a CPD and patients suffering from IPP represent very different collectives as far as age structure and morbidity are concerned. IPP patients frequently have erection problems even before the operation. Especially with IPP patients, preoperative erectile disfunction must be excluded, in the case of their occurrence there are to prefer other programmes of therapy.
... On the other hand, a high incidence of recurrence of the deformity is reported when absorbable sutures are used. 20 Typically these patients reported good initial results but with subsequent recurrence after few months. Probably 13 Nesbit 27 65% Mufti (1994) 13 Plicature 13 62% Sassine (1994) 14 Horizontal closing of longitudinal incision 23 95% Nooter (1994) 15 Plicature 33 76% Poulsen (1995) 16 Nesbit 48 91% Poulsen (1995) 16 Plicature 9 67% Ralph (1995) 17 Nesbit 359 82% Licht (1997) 18 Nesbit 28 79% Licht (1997) 18 Horizontal Long-term results with Nesbit's procedure G Savoca et al the stitches can not withstand the traction during repeated erections in the early postoperative period. ...
The objective was to assess sexual function at long-term follow-up after the Nesbit operation for Peyronie's disease. One hundred and fifty seven out of 213 patients treated between 1986 and 1998 using the Nesbit procedure were reassessed by means of IIEF-5 questionnaire together with two questions about residual deformity and treatment satisfaction. The results from this questionnaire together with the patient case records constitute the basis of this paper. After an average 72-month follow-up subjective patient determination of satisfaction indicated that 87.9% were satisfied with the results of surgery, 136 patients (86.7%) had good erectile function (IIEF-5 > 21). Shortening of the penis (from 1.5 to 3 cm) occurred in 22 patients (14%), but only in 2 (1.3%) was intercourse difficult because of excessive shortening. In conclusion, the Nesbit's operation results in the greatest amount of patient satisfaction about sexual function. When penile shortening occurs, it has not been a significant problem for patients who are properly counselled.
... Poulsen and Kirkeby described a success rate of 89% in the Nesbit group compared to 65% in the plication group [15]. Brake et al. found a similar result with 71% in the Nesbit group and 36% in the plication group [3]. Vatne et al. did not compare the different surgical techniques, but rather the results of both methods used for patients with Peyronie's disease or congenital deviation. ...
Different treatment options for penile curvature exist, such as the Nesbit procedure with complete excision of the tunica albuginea or the simple plication. We prefer a modification with only superficial excision, not opening the corpora cavernosa. From January 1997 to June 2000, 68 patients were treated surgically due to penile curvature. Data was obtained from 48 patients by telephone interview. The mean penile deviation was 46 degrees. Excision of the tunica was performed only superficially and non-absorbable inverted sutures were used. The mean follow-up time in this study was 25 months. A total of 36 (75%) patients were satisfied postoperatively, 12 were unsatisfied. Eleven (23%) patients described a complete straightening, 37 (77%) a rest-curvature of 5-50 degrees (mean 14 degrees ) and 21 (44%) described a shortening of 0.5-5 cm (mean 1.2 cm). Six patients reported a recurrence. No new erectile dysfunction occurred. Superficial excision of the tunica albuginea offers the advantage of tissue-contraction due to scarring without destroying the integrity of the corpora, leading in combination with non-absorbable inverted sutures to good functional and cosmetic results.
We present the use of a modified corporoplasty, based on geometrical principles, to determine the exact site for the incision in the tunica or plaque and the exact amount of albuginea for overlaying to correct with extreme precision the different types of congenital or acquired penile curvature due to Peyronie's disease. To describe our experience with a new surgical procedure for the enhancement of penile curvature avoiding any overcorrection or undercorrection. Between March 2004 and April 2013, a total of 74 patients underwent the geometrical modified corporoplasty. All patients had congenital curvature until 90° or acquired stable penile curvature 'less' than 60°, that made sexual intercourse very difficult or impossible, normal erectile function, absence of hourglass or hinge effect. Preoperative testing included a physical examination, 3 photographs (frontal, dorsal and lateral) of penis during erection, a 10 mcg PGE1-induced erection and Doppler ultrasound, administration of the International Index of Erectile Function (IIEF-15) questionnaire. A follow-up with postoperative evaluation at 12 weeks, 12 and 24 months, included the same preoperative testing. Satisfaction rates were better assessed with the use of validated questionnaire such as the International Erectile Dysfunction Inventory of the Treatment Satisfaction (EDITS). Statistical analysis with Student's t-test was performed using commercially available, personal computer software. A total of 25 patients had congenital penile curvature with a mean deviation of 46.8° (range 40-90), another 49 patients had Peyronie's disease with a mean deviation of 58.4 (range 45-60). No major complications were reported. Postoperative correction of the curvature was achieved in all patients (100%). Neither undercorrection nor overcorrection were recorded. No significant relapse (curvature>15°) occurred in our patients. Shortening of the penis was reported by 74% but did not influence the high overall satisfaction of 92% (patients completely satisfied with their sexual life). The erectile function was analyzed in both groups, Student's t-test showed a significant improvement in erectile function, preoperative average IIEF-15 scores were 17.43±4.67, whereas postoperatively it was 22.57±4.83 (P=0.001). This geometrical modified Nesbit corporoplasty is a valid therapy which allows penile straightening. The geometric principles make the technique reproducible in multicentre studies.International Journal of Impotence Research advance online publication, 11 August 2016; doi:10.1038/ijir.2016.28.
Objective: We review our results after surgical reconstruction with the Nesbit’s procedure for congenital or acquired penile deviation.
Patients and methods: Etiology of penile deviation, surgical outcome for straightening the penis, postoperative patient satisfaction and clinical findings were evaluated for 5 patients undergoing Nesbit’s procedure followed by a Medline review of contemporary literature regarding alternative surgical techniques. Follow-up included clinical examination, self-photography on erection and a standardized interview with erectile dysfunction assessment using IIEF-5 questionnaire.
Results: Overall patient satisfaction was 100% in two patients, 2 patients were partly satisfied and 1 patient reported no satisfaction because of severe penile shortening with insufficiency for sexual intercourse postoperatively. Preoperative mean angulation of the penis was 42°. Four patients had Peyronie’s disease and 1 patient’s curvature resulted from an untreated penile fracture during sexual intercourse.
Conclusion: The Nesbit technique can give satisfactory results for mild and moderate penile curvature. However, each technique for the reconstruction of penile deviation has its own advantages and disadvantages. Therefore proper patient selection has a major impact on further outcome.
To evaluate the outcome of the long-term follow-up in patients who underwent corporoplasty-straightening treatment for congenital penile curvature (CPC).
Between 1989 and 2012, a total of 60 patients underwent corporoplasty-straightening surgery using penile plication for CPC. We followed up on all the correction of the curvature; (a) any penile shortening; (b) sexual function; (c) complications.
The mean follow-up period was of 98 months. Complete correction of the curvature was obtained in 54 patients (90 %). Shortening of the penis (1.5 to not more than 3 cm) occurred in 16 patients (26.6 %). All patients had good erectile function (IIEF-5 > 21). The most frequent complication was the sensitivity reduction of the glans in five patients (8.3 %), which was resolved with in about a year after surgery (mean 11 months) and the shortening of the penis in 16 patients (26.6 %), which, however, did not result in problems during sexual intercourse.
Corporoplasty using penile straightening plication is a safe procedure whose results are maintained even after many years after surgery. It is a procedure that can be applied to any type of curvature. Any reduction in the length of the penis, as a result of the surgery procedure, does not lead to difficulties in sexual intercourse.
The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P = 0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.
To evaluate the outcome of the long-term follow-up in patients who underwent corporoplasty-straightening treatment for Peyronie's disease. Between 1990 and 2012, a total of 89 patients underwent corporoplasty-straightening surgery using penile plication for Peyronie's disease. We followed up on all the patients for the following: (a) the correction of the curvature; (b) any penile shortening; (c) sexual function; and (d) complications. The mean follow-up period was 103 months. Complete correction of the curvature was obtained in 81 patients (91%). Shortening of the penis (1.5 to <3 cm) occurred in 20 patients (22.5%) and 79 patients (88.7%) had good erectile function (International Index of Erectile Function (IIEF) 5> 21). The most frequent complication was the sensitivity reduction of the glans in eight patients (8.9%), which was resolved within about a year after surgery (mean 11 months) and the shortening of the penis in 20 patients (22.5%), which, however, did not result in problems during sexual intercourse. Corporoplasty using penile straightening plication is a safe procedure whose results are maintained for even many years after surgery. It is a procedure that can be applied to any type of curvature. Any reduction in the length of the penis, as a result of the surgery procedure, does not lead to difficulties in sexual intercourse.International Journal of Impotence Research advance online publication, 27 February 2014; doi:10.1038/ijir.2014.6.
Objective
Evaluate the results of Nesbit´s technique in patients with Peyronie´s disease.Methods and materialsBetween 1990 and 2002, 45 patients were treated using the Nesbit´s procedure to correct Peyronie´s disease curvature. Mean age was 57.6 (range 41-73). Dorso lateral incurvation was the most comon.ResultsTotal correction of the curvature in 40 patients (88%). High grade of satisfaction in 39 patientes (86.66%).Conclusion
Nesbit´s operation is an easy and effective surgical technique in the peyronie´s disease for curvature correction.
Seit einigen Jahren wird die Extrakorporale Stoßwellentherapie (ESWT) als neues nichtinvasives Therapieverfahren bei der Behandlung der Induratio penis plastica eingesetzt. Wir berichten über unsere Ergebnisse mit der ESWT bei einem mittleren Beobachtungszeitraum von 9 Monaten. Im Rahmen einer prospektiv angelegten Studie wurden 30 Patienten im Zeitraum von 3/99 bis 9/2000 therapiert, wovon 19 bereits erfolglos konservativ vorbehandelt waren. Regelmäßig wurde bei den Patienten eine dynamische Penissonographie und eine Befragung zu Schmerz und Erektionsfähigkeit durchgeführt. Bei durchschnittlich 4,5 Behandlungen pro Patient variierte die Anzahl der applizierten Stoßwellen zwischen 2000 und 4000 pro Plaque und Sitzung (Reflec-Tron/HMT-Kreuzlingen). Die Schmerzsymptomatik konnte bei 13/16 Patienten, die Penisdeviation bei 17/29, die Erektionsfähigkeit bei 13/24 gebessert werden. 17 von 30 Patienten berichteten über eine verbesserte GV-Qualität nach der Behandlung. Die ESWT stellt eine neue nebenwirkungsarme Therapiemethode bei der IPP dar, die auch bei bereits vorbehandelten Patienten noch erfolgversprechend angewendet werden kann.
Die operative Therapie der Induratio penis plastica ist keine kausale Therapie. Sie ist nur indiziert, wenn die Deviation die Kohabitation behindert, wenn erhebliche Schmerzen dabei bestehen oder eine anderweitig behandelbare erektile Dysfunktion vorliegt. Der Aufklärung des Patienten über das zu erwartende Ergebnis und mögliche Komplikationen ist außerordentlich wichtig. Wir können zwischen Plikatur- und in-/exzidierenden Verfahren mit plastischer Deckung und Methoden mit Penisprothesenimplantation unterscheiden. Bei den Plikaturverfahren sind Methoden mit Exzision eines Ellipsoids (z. B. Nesbit-OP) den Techniken ohne Ausschneidung (z. B. Essed-Schroeder) überlegen. Nachteil der Plikaturverfahren ist die Verkürzung des Penis. Bei den in-/exzidierenden Verfahren erfolgt die Defektdeckung entweder mit körpereigenen (z. B. Vene) oder Fremdmaterialien (z. B. TachoComb®). Eine eindeutige Überlegenheit eines bestimmten Verfahrens besteht dabei nicht. Folgende Resultate werden beschrieben: persistierende/rezidivierende Deviation 17 - 29 %, postoperative erektile Dysfunktion 0 - 33 %, Penisverkürzung 0 - 100 %, Zufriedenheit 50 - 85 %, Komplikationen 0 - 50 %. Die Indikation zur Penisprothesenimplantation besteht bei gleichzeitiger erektiler Dysfunktion (in der Regel veno-okklusiv). Welches Verfahren angewandt wird, sollte individuell von der jeweiligen Befundkonstellation und den Wünschen des Patienten abhängig gemacht werden.
Background:
Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Patients report negative effects in four major domains: physical appearance and self-image, sexual function and performance. These changes damage sexual life and compromise the quality of life. Our objective is to review the patient's sexual life after penile tunical plicature using the International Index of Erectile Function (IIEF) and the Sexual Encounter Profile (SEP) questionnaires.
Methods:
A total of 47 patients with Peyronie's disease (PD) were enrolled at our urology department and they underwent correction of penile deviation between February 2009 and March 2010. Mean patient age was 56 years and mean follow-up was 24 months. Patients with painless PD plaque with no progression in angulation for at least 12 months were chosen for surgery. They underwent a penile tunical plication.IIEF and SEP questionnaire were administered to all patients.
Results:
Of all treated patients, 94% were able to insert their penis in the partner's vagina (p<0.01; SEP question 2), compared with 62% preoperatively and 90% of them was satisfied overall with the sexual intercourse (p<0.01; SEP question 5) .Patients had a significantly higher endpoint and a greater change from baseline for the remaining SEP questions related to achievement of an erection, satisfaction of erection hardness (SEP questions 1 and 4; p < 0:001).We reported a significant improvement in the IIEF scores (from a baseline total score of 25.2 +/- 3.2 to a final score of 38.3 +/- 5.2; P<0.01). It resulted in significantly higher endpoint IIEF scores across all five IIEF domains: Erectile Function, Intercourse Satisfaction, Orgasmic Function, Sexual Desire and Overall Satisfaction. The main complaint was penile shortening (28 patients, 60%), feeling of the suture during flaccidity and tumescence (37 patients, 80%).
Conclusion:
Patient quality of life improved after surgery thanks to the improvement of their sexual life. The complications are unimportant and few bother symptoms are reported. The significant improvement in erectile function was also supported by IIEF and SEP questionnaire data. Nowadays tunical plication is a safe, advantageous and useful technique to treat patients suffering of Peyronie's disease.
Introduction:
We describe a new surgical technique for the treatment of penile curvature that combines features of the Nesbit procedure with features of tunical plication. U-shaped flaps of tunica albuginea are freed from the corpus cavernosum. The flaps are brought under the remaining tunica albuginea and are fixated with single absorbable sutures. As the defects of the tunica are sealed tightly and with high tensile strength by double layers of tunica albuginea, correction of the abnormal curvature is achieved.
Aim:
To present our experience with a new surgical technique for the treatment of penile curvature.
Methods:
Between 2008 and 2011, 50 patients underwent the underlap technique because of Peyronie's disease (37) or congenital penile deviation (13) in a single center.
Main outcome measures:
Preoperative and postoperative evaluation included the Erection Hardness Score (EHS) and the Symptom Score for Induratio penis plastica (IPP-SSC), a symptom score for penile deviation that was based on a consensus of regional andrologists. Clinical data concerning the early postoperative outcome were analyzed retrospectively using standardized items.
Results:
Mean age ± standard deviation was 59.7 ± 8.4 years for patients with Peyronie's disease and 34.1 ± 7.8 years for patients with congenital penile deviation. The mean follow-up period was 27 months. The major complication rate was 4%, overall satisfaction 86%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 6%. The mean difference of preoperative and postoperative IPP-SSC was 8.1 (95% confidence interval [CI] 7.24 to 8.96). The mean difference of preoperative and postoperative EHC was -0.03 (95% CI -0.16 to 0.09).
Conclusions:
Preliminary results obtained with the underlap technique showed promising outcome with minimal morbidity. The new technique might have three main advantages: more flexible intraoperative correctability of the curvature, tighter sealing of the tunical defects, and greater tensile strength of the plications.
Aim of the study is to evaluate the long-term results of tunica albuginea plication in patients with congenital curvature of the penis and to compare them with those obtained with the Nesbit technique.
Overall, 62 patients underwent surgical correction of congenital curvature of the penis from 2003 to 2008 at our institution. Of these, only 31 consented to be reevaluated. Nineteen patients had plication corporoplasty by means of one or more double crossed introflecting stitches (group A) while 12 patients had a traditional Nesbit technique with excision of small parts of tunica albuginea (group B). All patients were reevaluated with physical examination, a specific questionnaire and self-photography on erection, after a mean follow-up of 38 months in group A and 40 months in group B. Student's t test was employed for statistical analyses.
A total of 3 recurrences of curvature were observed in group A, 1-3 months after surgery, which required surgical correction. In all three patients, reabsorbable sutures had been employed for albuginea plication. No recurrences were observed in group B (P = 0.15). A minimal persistent deviation was present in 6 patients in group A (31%) and in 6 patients in group B (50%) (P = 0.29). A minimal hyposensitivity of glans and prepuce was reported in 7 patients in group A (38%) and in 9 patients in group B (75%) (P = 0.03).
Plication corporoplasty yields good and stable results when compared to the Nesbit technique provided that unabsorbable sutures are used and superficial scalpel incision of the albuginea is performed.
To determine the acceptability by patients of corporal plication for Peyronie's disease.
A postal questionnaire was sent to 69 patients who had undergone corporal plication for Peyronie's disease between 1992 and 1999, to ascertain the subjective outcome and acceptance by the patients and their sexual partners of the results of the procedure. Of the 65 patients who were still alive, 44 (68%) returned the questionnaire.
The mean (range) follow-up was 4.1 (0.5-7.25) years and the mean age of the patients 54.6 (32-80) years. Of the 44 patients responding, 24 (55%) were sexually active; after surgery, 16 (36%) had significant impairment of erections, seven (16%) continued to have significant penile discomfort and 15 (34%) could feel nodules at the suture site. Twenty-five (57%) patients reported a mild and six (14%) a severe persistent penile deformity; 40 (90%) reported having a shorter penis, of whom 22 (55%) thought it significant. Overall, 14 (32%) reported 'numbness' of the glans penis. Only 23 (52%) of the patients would recommend the surgery, with 25 (57%) reporting a deterioration in their overall quality of life. Of the partners of the evaluable patients, 38 (86%) responded, and a significant deterioration in sexual performance was reported by 19 (35%).
Overall, the long-term results of corporal plication appear to be disappointing. These poor results could be related to a current lack of understanding of the natural history and progression of the disease, to case selection, or to the surgery. We intend to use these results to counsel our patients before such surgery and inform them of the possible outcome in the long term.
This study evaluates the patients' judgement of the surgical outcome of the plication procedure, as described by Schröder and Essed, and the postoperative sexual functioning of patients with congenital curvatures and Peyronie's disease.
Of 98 patients treated for penile curvatures between 1985 and 1996, 85 patients received postoperatively a 'Questionnaire Assessing the Outcome of Surgery' and a short version of the 'Questionnaire for Screening Sexual Dysfunctions'.
28 patients with congenital curvatures and 31 with Peyronie's disease were evaluated. 75% of the patients with congenital curvatures and 58% of the patients with Peyronie's disease were satisfied with the result. Patients treated for Peyronie's disease reported diminished penile length and inability to have sexual intercourse more often than patients with congenital curvatures (90 vs. 64%, and 29 vs. 0%). After correction for age, patients with Peyronie's disease were less satisfied with their present sex life, had more frequent erectile problems and more trouble with considerable sexual desire than a group of 42 controls. For patients with Peyronie's disease satisfaction with the result was positively correlated with satisfaction with their present sex life and negatively correlated with the frequency of erectile problems. For patients with congenital curvatures satisfaction with the result was negatively correlated with both a postoperative curvature and a repeat operation.
Some patients with Peyronie's disease may not benefit from surgical correction (alone). Because of the occurrence of sexual problems, future evaluation of the role of pre- and postoperative sexological counselling in achieving better results is recommended.
To assess patient satisfaction with cosmetic and functional results after surgical correction for symptomatic penile curvature with the Nesbit procedure using postal questionnaire follow-up.
From 1991, 57 patients underwent surgery for a penile bend of greater than 30 degrees that was interfering with sexual function. Fifteen patients had mild to moderate erectile dysfunction on the preoperative assessment. In all patients, correction of curvature was performed by the Nesbit procedure after adequate preoperative counseling and informed consent. All patients were sent a questionnaire, and 42 men (76.4%) responded. The confidentiality of records was maintained at all times.
Our study shows that 38 patients (90.5%) had either a straighter penis (n = 26) or minor degrees of curvature of less than 30 degrees (n = 12); only 4 patients had severe curvature. Seven patients complained of some bumpy and narrowed areas, and nine noticed reduced sensory changes. Twenty-one patients complained of penile shortening but 16 reported that this did not affect their sexual performance. Overall, 32 patients were fairly satisfied with the operation-10 (23.8%) of 42 men reported dissatisfaction because of multiple factors. Of these, 6 patients had responded that they would not have undergone the procedure if they were able to turn the clock back.
Our long-term results after the Nesbit procedure are longer than that reported in any other series. Our results compare favorably with the short-term results of the modified Nesbit procedure, but simple/modified plication surgery results have not been so encouraging.
Essed-Schroeder plication is an established operative technique to correct congenital and acquired penile deviation. However, a third of all patients complain about discomfort from the suture material used. We prospectively evaluated patient satisfaction and quality of life after modified Essed-Schroeder plication by comparing 2 suture materials.
Between 1998 and 2001, 88 patients underwent surgical correction of penile deviation at our hospital. Mean patient age was 40 years (range 18 to 71) and mean followup was 30 months. Preoperatively penile curvature was greater than 20 degrees in all patients. A standardized questionnaire was sent to all patients. A total of 55 patients, including 30 with Peyronie's disease (PD) and 25 with congenital penile deviation (CPD), were available for evaluation and had complete followup.
In 25 of these patients (12 with PD and 13 with CPD) nonabsorbable polypropylene (PP) sutures were used for plication, whereas in the other 30 (18 with PD and 12 with CPD) nonabsorbable polytetrafluoroethylene (PT) sutures were used. In the PP group 22 of the 25 patients (88%) could notice the sutures (11 with PD and 11 with CPD), 10 had discomfort (6 with PD and 4 with CPD) and 3 had pain during penile erection (2 with PD and 1 with CPD). In the PT group 15 of the 30 patients (50%) could notice the sutures (10 with PD and 5 with CPD), 3 had discomfort (1 with PD and 2 with CPD) and 1 with PD had painful erections. Three patients had recurrent deviation, of whom 2 and 1 underwent plication with PP and PT, respectively.
These results indicate the PT is the more superior suture material with regard to postoperative patient discomfort after Essed-Schroeder correction of penile deviation. Nonabsorbable PT sutures do not impair the efficacy of the modified Essed-Schroeder plication technique and the success rate is not related to the underlying pathological condition.
For the correction of congenital and acquired penile deviations, there are two established operative methods: the Nesbit procedure and the Schroeder-Essed technique. However, which operative method is optimal with respect to the specific underlying pathology, is still controversial. The aim of the study was to evaluate patient satisfaction retrospectively after modified Essed-Schroeder plication using quality of life questionnaires.
Between June 1997 and June 2000, 59 patients underwent Essed-Schroeder at our institution for correction of a penile deviation. Mean patient age was 40 years (18 - 71) and mean follow-up 30 months (19 - 36). A standardised questionnaire was sent to all patients. Of these, the questionnaires completed by 50 patients could be assessed as valid.
Of these 50 patients, 22 suffered from a congenital penis deviation, 28 from Peyronie's disease. The percentage of patients who were able to perform sexual intercourse pre- and postoperatively was 62 % and 90 %, respectively. The proportion of patients who felt hampered during intercourse was reduced from 68 % to 48 %. Frequency of pain occurring during intercourse was diminished by half. Sixty percent of the patients would choose to have the same operation again, while 22 % were dissatisfied with the results. None of the patients showed complete erectile dysfunction after the operation. Seventy-four percent of the patients observed a decrease in penile length.
In patients with Peyronie's disease, the Schroeder-Essed technique with tunica plicature leds to significant improvement in relatively few cases. Alternative methods, such as the Nesbit corporoplasty, appear to be superior in these patients. In cases of congenital penile deviation, however, where the aim is cosmetic correction under maximum protection of erectile function, the Schroeder-Essed tunica plicature has shown good results with regard to penile function and quality of life.
To evaluate the outcome at long term follow-up after straightening corporoplasty of penile curvature due to Peyronie's disease.
Between 1986 and 2001 a total of 279 patients with Peyronie's disease were operated on using the Nesbit procedure. We were able to obtain complete follow-up data in 218 patients. The follow-up data included evaluation of complete correction of the curvature, penile shortening, sexual function, complications and subjective patient satisfaction.
After a median follow-up of 89 months subjective patient determination of satisfaction indicated that 83.5% were completely satisfied with the results of surgery. Complete correction of the penis was obtained in 86.3% of the patients. One hundred and ninety patients (87.1%) had good erectile function (IIEF-5 >21). Shortening of the penis (from 1.5 to more than 3 cm) occurred in 38 patients (17.4%), but only in 5 (2.3%) was intercourse difficult because of excessive shortening. Major sensory changes, confined to the glans area, were reported by 24 patients (11%).
The Nesbit operation is a simple and safe technique to correct the penile deformity due to Peyronie's disease. This technique results in the greatest amount of patient satisfaction about erectile function. The procedure can be used to correct all degrees of penile curvature successfully except for the short penis. Informed consent should be amply discussed before operating in regard to the risk of penile shortening and major sensory changes of the glans area.
Zwischen 1985 und 1992 wurden an der Urologischen Universitätsklinik Marburg 54 Patienten mit einer Penisdeviation operiert (kongenitale Deviationen n = 36, IPP-bedingte Deviationen n = 16, posttraumatische Deviationen n = 2). Operatiosntechniken: 35 Patienten wurden nach der Nesbit-Methode in Sleeve-Technik (kongenitale Deviationen n = 29; IPP-bedingte Deviationen n = 6), 13 Patienten in der Plikationstechnik nach Essed und Schroeder (kongenitale Deviationen n = 7, IPP-bedingte Deviationen n = 4, posttraumatische Deviationen n = 2) therapiert. Es erfolgten von 1985 bis 1989 5 Plaqueexzisionen und Deckungen mit Lyodura (IPP); 1991 1 Plaqueexzision, Spalthautdeckung und Penisprothese bei einer verkalkten ausgedehnten IPP mit dorsaler Deviation um 100°. Bei einer mittleren Nachbeobachtungszeit von 25 Monaten (max. 84 Monate) traten 7-11 Monate postoperativ 3 Rezidive (5,5 %) auf (1 nach Durapatch, 2 nach Nesbit), die operativ korrigiert wurden. 83 % der Patienten hatten postoperativ einen vollständig geraden Penis oder eine Restdeviation kleiner 10°, bei 17 % bestand eine nicht korrekturbedürftige Restdeviation von 10°-30°. 2 Patienten klagten über eine vorübergehende Sensibilitätsstörung der Glans. 2 Patienten entwickelten ein passageres postoperatives Lymphödem (OP ohne Zirkumzision).
Zwischen 1985 und 1990 wurden 43 Patienten mit Penisdeviationen (PD) (20 kongenitale und 23 erworbene PD) operiert. 5 Patienten wurden nach Nesbit, 11 Patienten nach Schröder-Essed in der Sleeve-Technik und 27 Patienten nach Schröder-Essed mit Hautinzision versorgt. Es traten insgesamt 2 Rezidive auf (nach Versorgung in der Schröder-Essed-Technik). Vorteile der Methode nach Schröder-Essed mit Hautinzision waren die kürzere Operationsdauer bei deutlich geringerer Komplikationsrate. 40 Patienten (20 kongenitale und 20 erworbene PD) konnten mittels eines Fragebogens zum Operationsergebnis evaluiert werden. Die Patienten mit kongenitaler PD waren fast durchweg subjektiv zufrieden. Dagegen wurden diejenigen mit erworbener PD von dem postoperativen Ergebnis nicht zufrie-dengestellt, offenbar weil sie in ihrem Befinden zusätzlich durch eine erektile Dysfunktion beeinträchtigt wurden, die bereits präoperativ bestand, aber anamnestisch nicht zu erfassen war. Daher sollte bei Patienten mit erworbener PD gezielt nach einer erektilen Dysfunktion gefragt werden. Liegt eine solche begleitend vor, muß sie primär im Behandlungskonzept berücksichtigt werden.
Five patients with Peyronie disease were treated successfully with a surgical technique derived from Nesbit's technique for the treatment of congenital curvature of the penis. Excision of ellipses of tunica albuginea from the convex side of the penis as described by Nesbit was not done, but instead the tunica was reeved with nonresorbable sutures to achieve straightening. The surgical technique combined with prior radiotherapy was successfully applied to patients with severe forms of Peyronie disease. More experience is necessary to establish the value of the proposed treatment concept.
For the first time in the literature, a syndrome that leads to ventral penile deviation is described-urethral manipulation syndrome (UMS, Kelâmi). This condition is due to fibrosis and scarring of corpus cavernosum urethrae (spongiosum) after any kind of urethral manipulation. In cases of impossible penetration, reconstructive surgery straightens the penis.
Surgical therapy for the correction of Peyronie's disease is indicated in patients with severe and chronic penile curvature that does not respond to conservative therapy and that is severe enough to prevent sexual intercourse. The penile prosthesis has been shown to be an effective treatment in patients with associated erectile impotence. However, there is disagreement regarding the procedure of choice in patients with Peyronie's disease and adequate erectile function. Because of the inconsistent results reported for grafting techniques, we used the Nesbit procedure in 12 patients with adequate erectile capacity distal to the plaque. Eleven patients reported satisfactory intercourse postoperatively with excellent anatomical results.
A total of 20 patients with Peyronie's disease, including 15 with erectile failure and 5 with normal potency, underwent evaluation with dynamic xenon washout and infusion cavernosography. Abnormal drainage from the cavernous body was found in 13 of the 15 patients with erectile failure and in none of the 5 potent patients (p less than 0.01), indicating that this condition seems to be the underlying pathological mechanism leading to erectile impotence in patients with Peyronie's disease.
The congenital curvature of the penis occurs very seldom. The bow string curvature is caused by an asymmetry of dimension in the tunica albuginea, who covers the corpora cavernosa. The orifice of the urethra is normally located. The patients can not perform coitus. Often the diagnosis can be made only with a photograph of the erectile penis. 1965 Nesbit first described a surgical correction. Several vertical elliptical segments of the tunica albuginea were closed with silk sutures. All results were reported to be perfect. To spare the erectile tissue in 4 cases were only gathered up the tunica albuginea by u-silk sutures. With this technique the functional and cosmetic results are also perfect.
The Nesbit operation gave excellent results in 85% of 22 men with erectile deformities of the penis due to various congenital causes. The dermal graft procedure has been abandoned for the treatment of Peyronie's disease as a result of an unacceptably high incidence of post-operative erectile problems. The Nesbit technique successfully corrected the erectile deformity in 77% of 62 men with Peyronie's disease. Those patients with Peyronie's disease and erectile impairment due to cavernous fibrosis are best treated by the insertion of a penile prosthesis.