Management of residual penile curvature after penile prosthesis placement

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.

Penile mass formation after neglected penile fracture:Surgical management with pericardial graft reinforcement

Background:Penile fracture is defined as the rupture of the tunica albuginea of the corpora cavernosa while in an erect state,during mostly intercourse or masturbation.Diagnosis of such condition is mainly clinical,while on the other hand,seeking medical attention is often delayed,and treatment options depend upon the time of presentation.Methods:This case report details a patient who developed a penile cystic fibro-hematoma lesion,2 months after a neglected penile fracture.After proper assessment including detailed history,physical exam and a penile doppler ultrasound,patient was elected for surgery.Results:The patient underwent surgical removal of the mass,correction of the curvature,and reinforcement of the weakened tunica albuginea with a pericardium graft.Postoperative course was uneventful.At follow-up,he reported normal erectile function with resolved penile curvature.Conclusion:This highlights the importance of seeking prompt medical attention for suspected penile fractures to avoid potential long-term complications.

Effects of patients'understanding and choice of surgical types on postoperative outcomes of Peyronie’s disease:a single-center retrospective study of 108 patients

Surgical correction can be considered for treating patients with a chronic phase of Peyronie’s disease(PD)and persistent penile curvature.In clinical practice,some patients pay too much attention to surgical complications and refuse the recommended feasible surgical types.Meanwhile,they require operations according to their preferences.This study aimed to evaluate the effects of patients’own choice of surgical type on postoperative satisfaction.This retrospective study analyzed data from 108 patients with PD who underwent surgical correction according to doctors’recommendations or patients’own demands.The objective and subjective surgical outcomes were assessed.Patients1 understanding of the disease was analyzed using a questionnaire survey.Objective measurements of surgical outcomes,including penile straightening,penile length,and sexual function,in patients who received the recommended surgery,were similar to those in patients who did not accept the recommended surgery.However,subjective evaluations,including erectile pain,discomfort because of nodules on the penis,and decreased sensitivity in the penis,were more obvious in patients who did not follow doctors’recommendations.In addition,a questionnaire survey showed that understanding PD and the purpose of surgery of patients who did not follow doctors’advice were inappropriate,as they did not conform to the principle of treatment.The present study showed that surgical correction seemed to be an objectively effective option in the management of patients in the stable chronic phase of PD.Low patient satisfaction might be related to patients’lack of correct understanding of the disease and its treatment strategy as well as unrealistic expectations.

A novel onlay urethroplasty for hypospadias with mild chordee after degloving:modified for complete removal of scar tissue underlying the urethral plate and for long-term outcomes

Urethral plate(UP)-preserving urethroplasty is simple and has few complications,but it may affect the development of penis in the long term and lead to recurrent chordee.In this study,we used obliquely cut UP to repair hypospadias with mild chordee after degloving(15°-30°)and compared the results with onlay urethroplasty to explore its rationality and feasibility.Between April 2018 and October 2020,108 hypospadias patients underwent onlay urethroplasty or modified onlay urethroplasty.Clinical data were prospectively collected,and medium-term outcomes were assessed at follow-up.The complications were compared between the two groups.Forty-four patients underwent the modified onlay procedure(GroupⅠ),with follow-up time(mean±standard deviation[s.d.])of 23.2±4.5(range:17-31)months.Sixty-four patients underwent a standard onlay procedure(GroupⅡ),with follow-up time(mean±s.d.)of 39.7±3.9(range:32-46)months.There was no difference in age at surgery.The urethral defect length and operative time were longer in GroupⅠ.Six cases of fistula and one case each of stricture and diverticulum were reported in GroupⅠ.In GroupⅡ,11 cases of fistula and one case each of stricture and diverticulum were reported.The complication rates were 18.2%and 20.3%in GroupⅠand GroupⅡ,respectively(P>0.05).These medium-term follow-up results demonstrate that the modified onlay procedure(oblique cut UP urethroplasty)is a safe and feasible technique for hypospadias with mild chordee after degloving.Compared with standard onlay urethroplasty,this modified procedure is conducive to the complete removal of scar tissue underlying the UP without increasing the risk of surgical complications.

New insights into the pathogenesis of Peyronie’s disease:A narrative review

Peyronie’s disease(PD)is a benign,progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea(TA)of the penis.This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines,cell signaling pathways,biochemical mechanisms,genetic factors responsible for fibrogenesis.A growing body of literature has shown that PD is a chronically impaired,localized,wound healing process within the TA and the Smith space.It is caused by the influence of different pathological stimuli,most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features,imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase(MMP/TIMP),and suppressed antioxidant systems during chronic inflammation.Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling.The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.

Effects of plication procedures in special cases of Peyronie’s disease:a single-center retrospective study of 72 patients

General recommendations regarding surgical techniques are not always appropriate for all Peyronie’s disease(PD)patients.Therefore,the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities.The clinical data from 72 patients who underwent plication procedures were analyzed in this study.Patients were divided into Groups A and B according to the curvature severity(≤60°or>60°)and Groups 1 and 2 according to the duration of disease stabilization(≥3 months or<3 months).At the 1-year follow-up,90.0%(36/40)and 90.6%(29/32)patients reported complete penile straightening,and 60.0%(24/40)and 100.0%(32/32)patients reported penile shortening in Groups A and B,respectively.No curvature recurrence occurred in any patient,and no significant differences were observed in postoperative International Index of Erectile Function–Erectile Function domain(IIEF-EF),erectile pain,sensitivity,or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization.However,the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2(mean±standard deviation[s.d.]:20.9±2.0 months and 14.3±1.2 months,respectively,P<0.001).The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature.In addition,the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.