Summary
- When surgery is needed for a curved penis
- The non-surgical option for the curved penis
- The 3 surgical techniques to operate on the curved penis
- 1. Shortening techniques
- 2. Stretching techniques
- 3. Penile prostheses
When surgery is necessary for a curved penis Induratio penis Plastica causes a curvature of the penis which makes intercourse painful, sometimes impossible and the men who suffer from it are estimated to be between 3 and 10% of those over 18. The curvature of the penis and generally dorsal, with the tip of the member facing the chest and with an angle that can reach over 90 degrees in the most severe degrees. On the shaft a thickening of the tunica albuginea forms, with fibrosis and subsequently a plaque or small nodules which, preventing the member from stretching, tend instead to make it curved. In these cases, an intervention for a curved penis can solve the problem as long as it is carried out in the appropriate time frame and according to the doctor’s opinion.The non-surgical option for a curved penis
To increase the
chances of solving the problem, it would be ideal to intervene before
the situation becomes stable. A first non-surgical option could
therefore consist in the injection of a collagenase-based drug to counteract hardening . In case
of pain, it is possible to proceed with the use of low intensity shock waves.
The intervention for
curved penis is generally performed in day
surgery, and the duration varies according to the technique that is performed
and the patient is sedated with
general or spinal anesthesia. At the end of the operation it is possible to obtain the total straightening of the member but to
resume sexual activity it is necessary to wait at least six weeks. The 3 surgical techniques to operate on the curved penis
These below are three surgical techniques used
to straighten the congenital curved penis:
We can
distinguish 3 types of surgical options: Shortening techniques 1. Shortening techniques Penis shortening
procedures include resection Nesbit’s cuneiform and plication techniques performed on the convex side of the penis.
They are intended to straighten the penile shaft by shortening
the long side of the penis, i.e. the convex side. They have a reduced risk of erectile deficit and good
curvature correction.
Recently
a new technique called STAGE (Kuehhas 2014) has been proposed based on the geometric excision of the superficial tunica albuginea
from the English Superficial Tunica Albuginea Geometric-based Excision
which represents an improved variant of the original Nesbit technique.
The
STAGE technique uses geometric principles to analyze the point of maximum
curvature and straighten the penis through repeated processing that involves
small superficial excisions in the points of maximum curvature in order to
limit the shortening compared to traditional techniques.
Ideal candidates for shortening techniques are patients with
:
- Erectile function intact or responsive to drug therapy
- Curvature
- Absence of complex deformities
- Absence of hourglass or hinge effect
- Loss of length due to disease
2. Lengthening techniques These
are designed to preserve penile length or to minimize shortening caused by Nesbit’s surgery or albuginea plication and allow for the correction of complex deformities. They are performed on the concave side of the penis and consist of a modified H or double Y incision at the point of maximum curvature followed by the placement of graft or graft. This allows the expansion of the tunic and a good correction of the curvature, to date the ideal material for grafting has yet to be identified. These procedures are associated with a 5 to 53% risk of erectile deficiency and an 8 to 12% recurrence of the curvature.
The presence of pre-operative erectile dysfunction, use of large grafts, age over 60, and ventral curvature are considered negative prognostic factors for functional outcome after surgical grafting.
Recently,
new techniques based on
geometric principles have been described with the aim of having an engraving area and a
much more accurate graft (Egydio et al. 2004; Miranda and Sampaio 2014).
Ideal candidates for lengthening techniques are patients with
:
- Erectile function intact or responsive to drug therapy
- Curvature> 60 degrees
- Deformed complex
- Destabilizing hinge effect
- Penile retraction and / or shortening
3. Penile prostheses They
represent the only possible solution in cases where the curvature is associated with erectile dysfunction resistant to common oral drugs (PDE5i).
In patients with mild-moderate curvature , an excellent result is obtained by simply inserting the cylinders. . In cases of severe curvature it is necessary to perform intra-operative modeling of the penis on the fully inflated cylinders by performing a counter-traction on the opposite side of the curvature for 90 seconds (Wilson’s maneuver). If there is a residual curvature of less than 30 °, no further treatments are performed, as the prosthesis acts as a tissue expander and will involve complete correction of the curvature in a few months.
If the
Wilson’s maneuver is not conclusive, the plate is incised and the graft is positioned to
achieve adequate straightening.
In
highly selected cases where
significant fibrous retraction has occurred with consequent
shortening, the following techniques can be considered:
- the sled technique
- The Modified Sled Technique (MoST)
It
is a complex and invasive procedure that consists in the
reconstruction and lengthening of the corpora cavernosa at the same time
as the insertion of penile prostheses and which should only be performed by
experienced surgeons.
If you need a
consultation or want to understand more, book an andrological visit,
only a specialist in the sector can help you solve the problem in
the most appropriate way possible.