Congenital Penile Curvature: Update and Management
Erectile Dysfunction (DK Montague, Section Editor)
First Online: 12 June 2012 DOI:
Cite this article as: Makovey, I., Higuchi, T.T., Montague, D.K. et al. Curr Urol Rep (2012) 13: 290. doi:10.1007/s11934-012-0257-x Abstract
Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible, at which point surgical repair is recommended. Excellent outcomes can be expected with surgical intervention. The three most commonly used repair techniques are the original Nesbit procedure, modified Nesbit procedure, and plication. Nesbit and modified Nesbit techniques require that an incision is made in the tunica albuginea while plication techniques utilize plicating sutures without an incision. While Nesbit and modified Nesbit techniques are more complex operations, these generally result in less recurrences and more satisfactory outcomes as opposed to the quicker and simpler plication technique.
Keywords Congenital chordee Congenital penile curvature Nesbit Congenital penile anomalies Penile plication Erectile dysfunction References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Nyirady P, Kelemen Z, Banfi G, et al. Management of congenital penile curvature. J Urol. 2008;179:1495–8.
Hsieh JT, Liu SP, Chen Y, et al. Correction of congenital penile curvature using modified tunical plication with absorbable sutures: the long-term outcome and patient satisfaction. Eur Urol. 2007;52:261–6.
Popken G, Wetterauer U, Schultze-Seemann W, et al. A modified corporoplasty for treating congenital penile curvature and reducing the incidence of palpable indurations. BJU Int. 1999;83:71–5.
Yachia D, Beyar M, Aridogan IA, et al. The incidence of congenital penile curvature. J Urol. 1993;150:1478–9.
Ebbehoj J, Metz P. Congenital penile angulation. Br J Urol. 1987;60:264–6.
Galen (c. 130–201 A.D.). In: Kuhn KC, editor. Claudii Galeni Opera Omnia, volume 10. New York: Cambridge University Press; 2011, p. 1001. First Published Leipzig, 1821–23.
Cassar P. A medico-legal report of the Sixteenth Century from Malta. Med Hist. 1974;18:354–9.
Smith ED. The history of hypospadias. Pediatr Surg Int. 1997;12:81–5.
Mettauet JP. Practical observation on those malformations on the male urethra and penis, termed hypospadias and epispadias with anaomalous case. Am J Med Sci. 1842;4:43.
Smith DR. Repair of hypospadias in the preschool child: a report of 150 cases. J Urol. 1967;97:723–30.
Cunha GR, Baskin L. Development of the penile urethra. Adv Exp Med Biol. 2004;545:87–102.
Hynes PJ, Fraher JP. The development of the male genitourinary system: III. The formation of the spongiose and glandar urethra. Br J Plast Surg. 2004;57:203–14.
Perriton CL, Powles N, Chiang C, et al. Sonic hedgehog signaling from the urethral epithelium controls external genital development. Dev Biol. 2002;247:26–46.
Baskin LS, Lee YT, Cunha GR. Neuroanatomical ontogeny of the human fetal penis. Br J Urol. 1997;79:628–40.
Cohn MJ. Development of the external genitalia: conserved and divergent mechanisms of appendage patterning. Dev Dyn. 2011;240:1108–15.
Devine Jr CJ. Horton CE: Chordee without hypospadias. J Urol. 1973;110:264–71.
Kramer SA, Aydin G, Kelalis PP. Chordee without hypospadias in children. J Urol. 1982;128:559–61.
Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol. 1998;160:1120–2.
Devine Jr CJ, Blackley SK, Horton CE, et al. The surgical treatment of chordee without hypospadias in men. J Urol. 1991;146:325–9.
Darewicz B, Kudelski J, Szynaka B, et al. Ultrastructure of the tunica albuginea in congenital penile curvature. J Urol. 2001;166:1766–8.
Adams MC, Chalian VS, Rink RC. Congenital dorsal penile curvature: a potential problem of the long phallus. J Urol. 1999;161:1304–7.
Catuogno C, Romano G. Androstanolone treatment for congenital penile curvature. Eur Urol. 2001;39 Suppl 2:28–32.
Kelami A. Congenital penile deviation and its treatment with the Nesbit-Kelami technique. Br J Urol. 1987;60:261–3.
• Basiri A, Sarhangnejad R, Ghahestani SM et al: Comparing absorbable and nonabsorbable sutures in corporeal plication for treatment of congenital penile curvature. Urol J 2011; 8: 302–6.
The authors further described plication technique and proposed that using absorbable sutures can lead to similar outcomes with lower rates of palpable nodules or sutures with plication technique.
Bracka A. A long-term view of hypospadias. Br J Plast Surg. 1989;42:251–5.
Cavallini G, Caracciolo S. Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature. Asian J Androl. 2008;10:512–9.
•• Leonardo C, De Nunzio C, Michetti P et al: Plication corporoplasty versus Nesbit operation for the correction of congenital penile curvature. A long-term follow-up. Int Urol Nephrol 2012; 44: 55–60.
The authors compared the differences between the Nesbit or modified Nesbit repair and the plication repair in 31 patients with long-term follow-up and delineates specific complication rates and differences between the two techniques. This is one of the few papers to compare different techniques of repair and highlights the need for further larger studies to help better describe differences in outcomes.
Rajmil O, Arrus J, Fernandez M, et al. Sensory changes after surgical correction of penile curvature. Int J Impot Res. 2009;21:366–71.
Poulsen J, Kirkeby HJ. Treatment of penile curvature–a retrospective study of 175 patients operated with plication of the tunica albuginea or with the Nesbit procedure. Br J Urol. 1995;75:370–4.
Hsieh JT, Huang HE, Chen J, et al. Modified plication of the tunica albuginea in treating congenital penile curvature. BJU Int. 2001;88:236–40.
Paez A, Mejias J, Vallejo J, et al. Long-term patient satisfaction after surgical correction of penile curvature via tunical plication. Int Braz J Urol. 2007;33:502–7. discussion 507-9.
•• Tal R, Nabulsi O, Nelson CJ et al: The Psychosocial Impact of Penile Reconstructive Surgery for Congenital Penile Deviation. Journal of Sexual Medicine 2010; 7: 121–8.
This is one of the few papers to address the psychological effects of congenital penile curvature and reconstructive surgery in a systematic and structured way. Specifics of the paper should be used in counseling patients regarding the upcoming surgery. Also it is a model and an incentive for further studies to help delineate outcomes of penile surgery.
Nesbit RM. Congenital curvature of the phallus: report of three cases with description of corrective operation. J Urol. 1965;93:230–2.
Jardin A, Wagner G, Khoury S, et al. Erectile dysfunction. First International Consultation on Erectile Dysfunction. Paris, July 1-3, 1999. United Kingdom: Health Publications; 2000.
Giammusso B, Burrello M, Branchina A, et al. Modified corporoplasty for ventral penile curvature: description of the technique and initial results. J Urol. 2004;171:1209–11.
Andrews HO, al-Akraa M, Pryor JP, et al. The Nesbit operation for congenital curvature of the penis. Int J Impot Res. 1999;11:119–22.
Rolle L, Tamagnone A, Timpano M, et al. The Nesbit operation for penile curvature: an easy and effective technical modification. J Urol. 2005;173:171–3. discussion 173-4.
Saalfeld J, Ehrlich RM, Gross JM, et al. Congenital curvature of the penis. Successful results with variations in corporoplasty. J Urol. 1973;109:64–5.
Yachia D. Modified corporoplasty for the treatment of penile curvature. J Urol. 1990;143:80–2.
Daitch JA, Angermeier KW, Montague DK. Modified corporoplasty for penile curvature: long-term results and patient satisfaction. J Urol. 1999;162:2006–9.
Ghanem H, Ghazy S, El-Meliegy A. Horizontal plication after vertical tunical incisions for the correction of congenital penile curvature. Int J Impot Res. 2000;12:117–9.
Ghanem H, Shamloul RM. Incisional corporoplasty for the correction of congenital penile curvature: a review of two suturing techniques. Int J Impot Res. 2008;20:222–5.
Sassine AM, Wespes E, Schulman CC. Modified corporoplasty for penile curvature: 10 years’ experience. Urology. 1994;44:419–21.
Essed E, Schroeder FH. New surgical treatment for Peyronie disease. Urology. 1985;25:582–7.
Chien GW, Aboseif SR. Corporeal plication for the treatment of congenital penile curvature. J Urol. 2003;169:599–602.
Hauck EW, Bschleipfer T, Diemer T, et al. Long-term results of Essed-Schroeder plication by the use of non-absorbable Goretex sutures for correcting congenital penile curvature. Int J Impot Res. 2002;14:146–50.
Lee SS, Meng E, Chuang FP, et al. Congenital penile curvature: long-term results of operative treatment using the plication procedure. Asian J Androl. 2004;6:273–6.
Nooter RI, Bosch JL, Schroder FH. Peyronie’s disease and congenital penile curvature: long-term results of operative treatment with the plication procedure. Br J Urol. 1994;74:497–500.
Schultheiss D, Meschi MR, Hagemann J, et al. Congenital and acquired penile deviation treated with the essed plication method. Eur Urol. 2000;38:167–71.
Van Der Horst C, Martinez Portillo FJ, Seif C, et al. Treatment of penile curvature with Essed-Schroder tunical plication: aspects of quality of life from the patients’ perspective. BJU Int. 2004;93:105–8.
Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol. 2002;167:2066–9.
Baskin LS, Duckett JW, Lue TF. Penile curvature. Urology. 1996;48:347–56.
Baskin LS, Lue TF. The correction of congenital penile curvature in young men. Br J Urol. 1998;81:895–9.
Hsu GL. Hypothesis of human penile anatomy, erection hemodynamics and their clinical applications. Asian J Androl. 2006;8:225–34.
Greenfield JM, Lucas S, Levine LA. Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol. 2006;175:238–41.
Moriel EZ, Grinwald A, Rajfer J. Vein grafting of tunical incisions combined with contralateral plication in the treatment of penile curvature. Urology. 1994;43:697–701.
Ho KL, Yip AW, Leung LS, et al. Surgical treatment of penile curvature. Hong Kong Med J. 2006;12:410–4.
Hatzichristou DG, Hatzimouratidis K, Apostolidis A, et al. Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results. J Urol. 2002;167:1367–70.
Ritchey ML, Ribbeck M. Successful use of tunica vaginalis grafts for treatment of severe penile chordee in children. J Urol. 2003;170:1574–6. discussion 1576.
Simonato A, Gregori A, Ambruosi C, et al. Congenital penile curvature: dermal grafting procedure to prevent penile shortening in adults. Eur Urol. 2007;51:1420–7. discussion 1427-8.
Badawy H, Morsi H. Long-term followup of dermal grafts for repair of severe penile curvature. J Urol. 2008;180:1842–5.
Lentz AC, Carson 3rd CC. Peyronie’s surgery: graft choices and outcomes. Curr Urol Rep. 2009;10:460–7.
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