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Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature
Abstract
Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007, 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie’s disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration, and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycron® 2/0 polyester fiber).
Results: After a mean follow-up period of 18 months, successful results with respect to penile straightening, normal erection, penetration and sensation, confirmed both subjectively and objectively, were achieved in all patients. Post-operative penile shortening of less than 1.5 cm
was present in 50% of the cases, but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100% (35/43 very satisfied and 8/43 satisfied).
Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful outcomes are: clear identification of the line of maximum curvature, adequate pre-operative evaluation, counseling of the patient to set
appropriate expectations, and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle, which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea, which may prevent postoperative erectile dysfunction, is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity.
Results: After a mean follow-up period of 18 months, successful results with respect to penile straightening, normal erection, penetration and sensation, confirmed both subjectively and objectively, were achieved in all patients. Post-operative penile shortening of less than 1.5 cm
was present in 50% of the cases, but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100% (35/43 very satisfied and 8/43 satisfied).
Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful outcomes are: clear identification of the line of maximum curvature, adequate pre-operative evaluation, counseling of the patient to set
appropriate expectations, and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle, which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea, which may prevent postoperative erectile dysfunction, is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity.
