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 （CPC...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.展开更多
Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fif...Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fifty-four patients （mean age 24 years, range 20-31 years） whose congenital penile deviation due to physiological curvature was ≥ 25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde＇s parameters （contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability）. All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Results： Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. Conclusion： The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.展开更多
Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using...Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique.Materials and methods:This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea(Essed-Schroeder technique)with a covering pair of absorbable sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The postoperative means(ranges)of penile curvature and length were significantly different from that of the preoperative values at 3(5[0-20]degrees and 14.5[9-18.5]cm),6(5[0-20]degrees and 14.5[9-18.5]cm),and 12 months(5[0-30]degrees and 14.5[9-18.5]cm;all p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.展开更多
文摘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.
文摘Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fifty-four patients （mean age 24 years, range 20-31 years） whose congenital penile deviation due to physiological curvature was ≥ 25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde＇s parameters （contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability）. All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Results： Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. Conclusion： The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.
文摘Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique.Materials and methods:This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea(Essed-Schroeder technique)with a covering pair of absorbable sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The postoperative means(ranges)of penile curvature and length were significantly different from that of the preoperative values at 3(5[0-20]degrees and 14.5[9-18.5]cm),6(5[0-20]degrees and 14.5[9-18.5]cm),and 12 months(5[0-30]degrees and 14.5[9-18.5]cm;all p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.
