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Current Urology Reports

, Volume 13, Issue 4, pp 290–297 | Cite as

Congenital Penile Curvature: Update and Management

  • Iryna Makovey
  • Ty T. Higuchi
  • Drogo K. Montague
  • Kenneth W. Angermeier
  • Hadley M. Wood
Erectile Dysfunction (DK Montague, Section Editor)

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 

Notes

Disclosures

No potential conflicts of interest relevant to this article were reported

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Nyirady P, Kelemen Z, Banfi G, et al. Management of congenital penile curvature. J Urol. 2008;179:1495–8.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Yachia D, Beyar M, Aridogan IA, et al. The incidence of congenital penile curvature. J Urol. 1993;150:1478–9.PubMedGoogle Scholar
  5. 5.
    Ebbehoj J, Metz P. Congenital penile angulation. Br J Urol. 1987;60:264–6.PubMedCrossRefGoogle Scholar
  6. 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.Google Scholar
  7. 7.
    Cassar P. A medico-legal report of the Sixteenth Century from Malta. Med Hist. 1974;18:354–9.PubMedGoogle Scholar
  8. 8.
    Smith ED. The history of hypospadias. Pediatr Surg Int. 1997;12:81–5.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    Smith DR. Repair of hypospadias in the preschool child: a report of 150 cases. J Urol. 1967;97:723–30.PubMedGoogle Scholar
  11. 11.
    Cunha GR, Baskin L. Development of the penile urethra. Adv Exp Med Biol. 2004;545:87–102.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Baskin LS, Lee YT, Cunha GR. Neuroanatomical ontogeny of the human fetal penis. Br J Urol. 1997;79:628–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Cohn MJ. Development of the external genitalia: conserved and divergent mechanisms of appendage patterning. Dev Dyn. 2011;240:1108–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Devine Jr CJ. Horton CE: Chordee without hypospadias. J Urol. 1973;110:264–71.PubMedGoogle Scholar
  17. 17.
    Kramer SA, Aydin G, Kelalis PP. Chordee without hypospadias in children. J Urol. 1982;128:559–61.PubMedGoogle Scholar
  18. 18.
    Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol. 1998;160:1120–2.PubMedCrossRefGoogle Scholar
  19. 19.
    Devine Jr CJ, Blackley SK, Horton CE, et al. The surgical treatment of chordee without hypospadias in men. J Urol. 1991;146:325–9.PubMedGoogle Scholar
  20. 20.
    Darewicz B, Kudelski J, Szynaka B, et al. Ultrastructure of the tunica albuginea in congenital penile curvature. J Urol. 2001;166:1766–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Adams MC, Chalian VS, Rink RC. Congenital dorsal penile curvature: a potential problem of the long phallus. J Urol. 1999;161:1304–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Catuogno C, Romano G. Androstanolone treatment for congenital penile curvature. Eur Urol. 2001;39 Suppl 2:28–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Kelami A. Congenital penile deviation and its treatment with the Nesbit-Kelami technique. Br J Urol. 1987;60:261–3.PubMedCrossRefGoogle Scholar
  24. 24.
    • 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. PubMedGoogle Scholar
  25. 25.
    Bracka A. A long-term view of hypospadias. Br J Plast Surg. 1989;42:251–5.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    •• 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. PubMedCrossRefGoogle Scholar
  28. 28.
    Rajmil O, Arrus J, Fernandez M, et al. Sensory changes after surgical correction of penile curvature. Int J Impot Res. 2009;21:366–71.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    •• 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. PubMedCrossRefGoogle Scholar
  33. 33.
    Nesbit RM. Congenital curvature of the phallus: report of three cases with description of corrective operation. J Urol. 1965;93:230–2.PubMedGoogle Scholar
  34. 34.
    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.Google Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    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.PubMedGoogle Scholar
  39. 39.
    Yachia D. Modified corporoplasty for the treatment of penile curvature. J Urol. 1990;143:80–2.PubMedGoogle Scholar
  40. 40.
    Daitch JA, Angermeier KW, Montague DK. Modified corporoplasty for penile curvature: long-term results and patient satisfaction. J Urol. 1999;162:2006–9.PubMedCrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    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.PubMedCrossRefGoogle Scholar
  43. 43.
    Sassine AM, Wespes E, Schulman CC. Modified corporoplasty for penile curvature: 10 years’ experience. Urology. 1994;44:419–21.PubMedCrossRefGoogle Scholar
  44. 44.
    Essed E, Schroeder FH. New surgical treatment for Peyronie disease. Urology. 1985;25:582–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Chien GW, Aboseif SR. Corporeal plication for the treatment of congenital penile curvature. J Urol. 2003;169:599–602.PubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    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.PubMedGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    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.PubMedCrossRefGoogle Scholar
  50. 50.
    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.CrossRefGoogle Scholar
  51. 51.
    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.PubMedCrossRefGoogle Scholar
  52. 52.
    Baskin LS, Duckett JW, Lue TF. Penile curvature. Urology. 1996;48:347–56.PubMedCrossRefGoogle Scholar
  53. 53.
    Baskin LS, Lue TF. The correction of congenital penile curvature in young men. Br J Urol. 1998;81:895–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Hsu GL. Hypothesis of human penile anatomy, erection hemodynamics and their clinical applications. Asian J Androl. 2006;8:225–34.PubMedCrossRefGoogle Scholar
  55. 55.
    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.PubMedCrossRefGoogle Scholar
  56. 56.
    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.PubMedCrossRefGoogle Scholar
  57. 57.
    Ho KL, Yip AW, Leung LS, et al. Surgical treatment of penile curvature. Hong Kong Med J. 2006;12:410–4.PubMedGoogle Scholar
  58. 58.
    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.PubMedCrossRefGoogle Scholar
  59. 59.
    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.PubMedCrossRefGoogle Scholar
  60. 60.
    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.PubMedCrossRefGoogle Scholar
  61. 61.
    Badawy H, Morsi H. Long-term followup of dermal grafts for repair of severe penile curvature. J Urol. 2008;180:1842–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Lentz AC, Carson 3rd CC. Peyronie’s surgery: graft choices and outcomes. Curr Urol Rep. 2009;10:460–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Iryna Makovey
    • 1
  • Ty T. Higuchi
    • 1
  • Drogo K. Montague
    • 1
  • Kenneth W. Angermeier
    • 1
  • Hadley M. Wood
    • 1
  1. 1.Glickman Urological and Kidney InstituteCleveland ClinicClevelandUSA

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