Stepwise Superficial Tunica Albuginea Excisions to correct complex congenital penile curvature

Luca Mavilla1, Luca Albanesi1, Francesco Attisani1, Barbara Cristina Gentile1, Gabriella Mirabile1, Francesco Pisanti1, Giorgio Vincenti1, Manlio Schettini1, Roberto Giulianelli1
  • 1 Nuova Villa Claudia (Roma)

Objective

Congenital penile curvature may cause pain, hardened, big, cord-like lesions (scar tissue known as "plaques"), or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea.
Congenital penile curvature can present with both uniplanar and biplanar defects, the latter of which entails more technically demanding surgery. To demonstrate the efficacy and safety of our novel technique of multiple, small, superficial tunica albuginea excisions based on geometrical principles, for correcting biplanar congenital penile curvature. The procedure is based on the geometrical principles of the Egydio technique for any kind of penile curvature correction and objectified the curvature. We evaluated the rate of successful penile straightening, the complication rate, and patient satisfaction.

Methods and results

Between June 2006 and March 2012, 145 patients with disabling congenital biplanar ventro-lateral (n = 131; 90.3%) or dorso-lateral (n = 14; 9.7%) curvature of the penis underwent stepwise superficial tunica albuginea excisions. The mean follow-up period was 21 months (range, 6–62 months). The procedure is based on the geometrical principles of the Egydio technique for any kind of penile curvature correction and objectified the curvature. Multiple 3-mm excisions of the superficial tunica albuginea were performed without compromising the inner layer of the tunica albuginea, thus resulting in a stepwise correction of the curvature and improved distribution of the bending force of the curvature.

Discussion

We evaluated the rate of successful penile straightening, the complication rate, and patient satisfaction. Mean age at surgery was 23.8 years (range, 15–47 years). Mean degree of curvature was 65° (range, 45–90°). There was no recurrent curvature. No intra- or post-operative complications were encountered. Complete correction of the penile axis was obtained in 98.6% (n = 143). The excellent functional outcomes resulted in a high level of patient satisfaction, including improved self-esteem, libido, sexual intercourse, and psychosexual relief. Two patients had a residual curvature of up to 30° requiring a re-operation.
We recommend this novel technique as the optimal surgical intervention for correcting both uniplanar and biplanar congenital deviations.

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