The aim of this article is to analyse the long-term results of different surgical techniques for correction of penile deviations in Peyronie＇s disease. Patients who underwent surgery for a penile deviation in Peyroni...The aim of this article is to analyse the long-term results of different surgical techniques for correction of penile deviations in Peyronie＇s disease. Patients who underwent surgery for a penile deviation in Peyronie＇s disease between 1997 and 2007 were included into this study. Cases were retrospectively analysed by chart review. The current situation was evaluated by a 16-item standardized questionnaire addressing penile straightness, sensation, length, sexual function and satisfaction. Ninety patients were contacted with a return rate of 75 （83%） evaluabie questionnaires. Thirty-two patients were operated by shortening techniques （STs） with either Schroeder-Essed （n= 16） or Nesbit （n= 16）. Forty-three were operated by a plaque in-lexcision and defect covering by TachoSil method （TM）. Both groups were similar regarding age （ST 56 years, TM 57 years）, comorbidities, mean preoperative erection hardness score （EHS; 3.1 ST, 3.4 TM） and time of follow-up （total mean, 63 months）. Preoperatively ST patients had significantly less plaques （P〈0.05） and a lower deviation angle in comparison to TM patients （ST 56° versus TM 74°; P〈 0.001）. Still TM patients reported slightly better straightening results, but a significantly lower mean EHS （ST 3.3 versus TM 2.6; P〈0.001） during the follow-up. Satisfaction rates were similar in both groups. In conclusion, both techniques revealed to be safe and sustainable successful in penile straightening with better functional outcome of patients operated by STs.展开更多
The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle （NVB） to correct ventral congenital penile curvatures （CPC...The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle （NVB） to correct ventral congenital penile curvatures （CPCs）. The bundle was mobilized using the medial and lateral dissection technique in 21 （Group 1） and 13 （Group 2） patients, respectively. In the medial technique, Buck＇s fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea （TA） is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck＇s fascia above the urethra at the 5 and 7 o＇clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients＇ photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 （P= 0.01）. In Group 1, nine patients （42.8%） required one diamond excision, 10 （47.6%） required two diamond excisions and two （9.5%） required more than two excisions; in Group 2, six patients （46.2%） required two diamond excisions and seven patients （53.8%） required more than two diamond excisions （P = 0.019）. The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.展开更多
Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fif...Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fifty-four patients （mean age 24 years, range 20-31 years） whose congenital penile deviation due to physiological curvature was ≥ 25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde＇s parameters （contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability）. All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Results： Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. Conclusion： The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.展开更多
文摘The aim of this article is to analyse the long-term results of different surgical techniques for correction of penile deviations in Peyronie＇s disease. Patients who underwent surgery for a penile deviation in Peyronie＇s disease between 1997 and 2007 were included into this study. Cases were retrospectively analysed by chart review. The current situation was evaluated by a 16-item standardized questionnaire addressing penile straightness, sensation, length, sexual function and satisfaction. Ninety patients were contacted with a return rate of 75 （83%） evaluabie questionnaires. Thirty-two patients were operated by shortening techniques （STs） with either Schroeder-Essed （n= 16） or Nesbit （n= 16）. Forty-three were operated by a plaque in-lexcision and defect covering by TachoSil method （TM）. Both groups were similar regarding age （ST 56 years, TM 57 years）, comorbidities, mean preoperative erection hardness score （EHS; 3.1 ST, 3.4 TM） and time of follow-up （total mean, 63 months）. Preoperatively ST patients had significantly less plaques （P〈0.05） and a lower deviation angle in comparison to TM patients （ST 56° versus TM 74°; P〈 0.001）. Still TM patients reported slightly better straightening results, but a significantly lower mean EHS （ST 3.3 versus TM 2.6; P〈0.001） during the follow-up. Satisfaction rates were similar in both groups. In conclusion, both techniques revealed to be safe and sustainable successful in penile straightening with better functional outcome of patients operated by STs.
文摘The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle （NVB） to correct ventral congenital penile curvatures （CPCs）. The bundle was mobilized using the medial and lateral dissection technique in 21 （Group 1） and 13 （Group 2） patients, respectively. In the medial technique, Buck＇s fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea （TA） is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck＇s fascia above the urethra at the 5 and 7 o＇clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients＇ photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 （P= 0.01）. In Group 1, nine patients （42.8%） required one diamond excision, 10 （47.6%） required two diamond excisions and two （9.5%） required more than two excisions; in Group 2, six patients （46.2%） required two diamond excisions and seven patients （53.8%） required more than two diamond excisions （P = 0.019）. The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.
文摘Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fifty-four patients （mean age 24 years, range 20-31 years） whose congenital penile deviation due to physiological curvature was ≥ 25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde＇s parameters （contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability）. All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Results： Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. Conclusion： The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.
