Isolated ventral congenital penile curvature treated by incisionless plication of tunica albuginea in adults: A prospective case series

Abstract

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.

Keywords: Congenital penile curvature; Incisionless plication; Isolated penile curvature; Tunica albuginea; Ventral penile curvature.

Figure 1

A 23-year-old single patient presented with an IVCPC that was corrected by incisionless tunical plication and followed-up for 12 months. Preoperative and postoperative photos of the corrected curvature are shown. (A) Preoperative photo showing an erect penis with a curvature of 50 degrees and penile length of 18 cm. (B) Postoperative photo at 1 month. (C) Postoperative photo at 6 months. (D) Postoperative photo at 12 months.

Figure 2

The initial surgical steps of the incisionless plication technique. (A) Circumferential incision at the circumcision scar. (B) Complete penile degloving without mobilization of the neurovascular bundle. (C) Application of tourniquet. (D) An artificial erection was obtained by intracavernosal saline injection.

Figure 3

The suturing steps of the incisionless plication technique. (A) Surgical pen marks at the site of the plication suture. (B) Two pairs of stitches of nonabsorbable sutures (Prolene 2/0) were placed through the full thickness of the tunica albuginea. (C) Additional stitches of absorbable sutures (Vicryl) were added to cover the nonabsorbable (Prolene) sutures. (D) The artificial erection was carried out once more to ensure the complete straightening of the penis.