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Ces Urol 2016; 20(1): 48–56
ORIGINÁLNÍ PRÁCE
(“using selfies”) at 3 to 6/9 to 12 months postope‑
ratively.
DESCRIPTION OF THE
TECHNIQUE
As already established and described by Egydio et
al. previously (8, 9), the penis was degloved using
a circumferential subcoronal incision and an artifi‑
cial erection (21 gauge needle with subsequent sa‑
line solution infiltration into cavernosal body) was
induced to assess the degree of deformity and the
point of maximal curvature (Fig. 1A). At this point,
an accurate dissection of the Buck’s fascia paraure‑
thrally was made. Then the neurovascular bundle
was mobilized with blunt/sharp dissection to the
midline of the dorsal convex side of the penis. An
artificial erection was induced by intracavernous
injection of saline solution using a 21-gauge needle
into a cavernous body (through the glans or the
lateral side of the cavernous body) again.
Afterwards, an incomplete circumferential
double Y incision of the tunica albuginea at the
place of hourglass deformity/or point of maximal
curvature was made. For dorsal, dorsolateral and
lateral curvatures, the incision in the tunica albu‑
ginea was made 5mm lateral or almost close to
the lateral borders of the urethra. There was no
necessity to mobilize the urethra. In two cases of
lateral plaque localization, we performed a com‑
plete plaque excision (Fig. 1B). A small fragment
of plaque has been excised in all cases, in order
to remove the area of maximal cicatrisation. With
the penis under traction, the size of the defect in
the tunica was measured once again in order to
re-approve the initial measurement. The defect
was covered with a bovine pericardium collagen
matrix graft
(Supple Peri-Guard 6x8 cm, Synovis
Surgical Innovations, W. St. Paul, MN, USA)
that was
sutured to the tunica albuginea using a continu‑
ous 4–0 PDS
suture (Fig. 1C). Before grafting, pe‑
ricardial material was re-hydrated in a 0.9% saline
solution for 5–15 min. The complete straightening
of the penis was confirmed intraoperatively with
an artificial erection in all patients. In our patients
sample, with respect to the residual (dorsal, ventral,
contralateral) minor curvature (<30°) we decided
to place additional few PDS 4.0 sutures directly on
the graft to optimize the curvature (Fig. 1E). Finally,
the last artificial erection was induced. We have
performed circumcision in 3 patients, for the rest
we used foreskin sparing approach.
In one case, we had to place additional STAGE
sutures to obtain the straight penis (Fig. 1D). With
regard to the STAGE technique (12), we performed
an eliptical superficial incisions (cca 4x3 mm) of the
tunica on the contralateral side to the primary peri‑
card sutures (Fig. 1D/F). The newly generated tissue
defect was closed with 3–4 absorbable PDS 4.0
sutures in an double crossed introflecting fashion.
At the end of the procedure a gentle compre‑
ssion was applied to the penis, which was elevated
and fixed to suprapubic area. Patients were dischar‑
ged on the postoperative day 1 and recommended
to refrain from any form of sexual intercourse for
6 weeks.
RESULTS
Each patient indicated for the surgery had biplanar
deformity, compromising the sexual intercour‑
se.
There was no need to perform circumcision,
because in our cohort we did not observe any
foreskin abnormalities. Nevertheless, we have per‑
formed foreskin-sparing approach in 6 patients.
The remaining three candidates wanted to avoid
all the potential risks concerning prepucium-spa‑
ring procedure. Perioperatively we found typical
hourglass deformity in (6 pts).
Macroscopically
between the neurovascular bundle on the dorsal
aspect of the penis and the plaque, we had found
always enlarged perforator veins (with 2–3 mm
in largest diameter) in all cases. This finding of
potential venous leakage could be responsible for
compromising the rigidity of the penis and final
overall ED status
(13).
All plaques were located on
the dorsal side of the penis, except for two found
on the lateral aspect of the penis.
The size of the
plaque varied from 1.8x1 cm to 4.5x2.5 cm. None
of the patients had history or was
presented with