BERKELEY, CA (UroToday.com) -
Introduction: Penile plication of the tunica albuginea is a well-established technique for the treatment of penile curvature. It involves shortening the convex side of the penile curve without excising the tunica. Dot plication involves no dissection of the tunica or the urethra and straightens the penis. This technique classically utilizes permanent sutures for the plication of the tunica. Major drawbacks include that patients may feel the knots subcutaneously and report pain with erections.
Materials and Methods: Eight patients with stable Peyronie’s disease presented for consideration of surgical treatment. These patients were noted to have curves ranging from 20 to 95 degrees with good erectile function. After a discussion specific to therapy with these patients, including other surgical options, they chose to undergo penile plication. After an erection was pharmacologically induced, a paramedian longitudinal penile incision was made opposite the location of the curvature. The tunica was marked initially utilizing either an 8, 16, 20 or 24 dot technique. The tunica was then plicated utilizing absorbable monofilament 3-0 Biosyn® sutures.
Results: Eight patients underwent plication procedures for Peyronie’s disease. With a mean follow up of 5 months, the patients reported mild post-operative discomfort from the incision, and minimal residual curvature of an average of less than 5 (2.5-8) degrees. After 4-month follow-up period, patients denied feeling the knots subcutaneously.
Conclusion: Plication of the tunica albuginea utilizing a paramedian incision bypasses the need for formal de-gloving of the penis. Here we demonstrate our technique using a longitudinal incision and absorbable synthetic sutures rather than the standard permanent sutures. Absorbable sutures provide the potential advantage of avoiding permanent palpable sutures and pain with erection secondary to retained sutures. We feel this combination approach and suture selection has optimized both surgical outcomes and recovery.
Written and produced by:
Daniel R. Martinez,* Tariq S. Hakky, Justin Parker, Bryan J. Allen, Jorge L. Lockhart, and Rafael Carrion as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
*PGY-4, Department of Urology
University of South Florida
Peyronie's disease: Still a surgical disease - Abstract
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