The correction of congenital penile curvature in young men

Abstract

To determine the long-term outcome of multiple parallel plication (MPP) used for correcting congenital penile curvature (with normal urethra and corpus spongiosum), a technique which takes account of the greater force of erection in young men (mean arterial pressure ≃ 100 mmHg) than in neonates (≃ 60 mmHg). Patients and methods: All young men who underwent surgical correction of congenital penile curvature using the multiple parallel plication technique between 1992 and 1995 were reviewed, from their charts and by a telephone survey. Results Ten patients (mean age 22.3 years, SD 4, range 17-29) were identified, all of whom had been followed for more than one year (mean 2.8, sn 1.3, range 1.2-4.8). All 10 patients reported a preoperative curvature of 60-90°; postoperatively, eight of the 10 patients had a successful outcome, based on self-documentation of a straighter penis (eight) and/or satisfactory intercourse (four). Two of these eight requested follow-up plications to correct a residual curvature of 15°. All patients reported feeling the sutures as a small bump on the dorsal aspect of the penis. In one patient this was considered bothersome, but it did not interfere with intercourse. In one patient the curvature recurred 5 weeks after surgery, following intercourse. Another patient was lost to follow-up and could not be evaluated. Conclusion The MPP technique has the following advantages: it entails no dissection of the neurovascular bundle or corpus spongiosum of the tunica, avoiding complications (such as impotence and urethral injury) that may occur with manipulation of these structures; it can be performed under local anaesthesia and can be completed within 30 min; suture cut-through is unlikely because the dorsum (12 o'clock position) of the tunica albuginea is the thickest and hence strongest area of the corporal body; and the straightness of the penis can be determined easily because erection is sustained throughout the procedure. The disadvantages of the MPP technique are; several small bumps from the nonabsorbable sutures may be palpable, and the patient needs to be informed of this preoperatively; aspiration and phenylephrine injection may be required to prevent priapism.