- Email: [email protected]
857The surgical treatment of peyronie's disease with the use of free auto graft of buccal mucosa
857
858
THE SURGICAL TREATMENT OF PEYRONIE'S DISEASE W I T H THE USE OF FREE AUTO GRAFT OF BUCCAL MUCOSA
S U R G I C A L REPAIR OF THE PENILE SUSPENSORY L I G A M E N T
Shioshvili T., Kakonashvili A.
Institute of Urology, London, United Kingdom
State Medical Academy, Department of Urology, Tbilisi, Georgia I N T R O D U C T I O N & OBJECTIVES: Conservative and palliative methods of treatment in case of Peyronie's disease (PD) are not always effective. The aim of
this work was the evaluation of clinical results of buccal mucosa use for replacement of indurative plaque. MATERIAL & METHODS: Twenty-six patients were under observation. They underwent the following investigations before and periodically within 3 years after the treatment: International Index of Erectile Function, manual
examination of plaque, conventional and power colour Doppler sonography of penis, Peno-Brachiai Index before and its increase after the intracavernous injection of papaverin, measurements of penile length, curvature angle and direction in the phase of rigidity. After stabilization in plaque's development the patients underwent the plaque's excision and its replacement by free auto graft of buccal mucosa.
Li C.Y., Kumar P., Christopher N., Minhas S., Ralph D.
I N T R O D U C T I O N & OBJECTIVES: The suspensory apparatus of the penis consists of the fandiform ligament and the suspensory ligament proper. The penile suspensory ligament serves to support and maintain the erect penis in an upright position during sexual intercourse. This paper assesses the management of patients who presented with an abnormality of the suspensory ligament and subsequently had it repaired. MATERIAL & METHODS: The diagnosis was made clinically, often by the presence of a palpable gap between the symphysis pubis and the penis and / or following a pharmacologically induced erection. The suspensory ligament was approached via a transverse suprapubic incision and the ligament repair performed using an average of four 1/O Ethibond sutures inserted from the midline tunica to the symphysis pubis. At the end of the procedure, an artificial erection was induced to check that the penis was straight and in a functionally desirable position. A total of 62 patients were included, with a mean age of 28 years (range of 14 5 lyrs). The underlying aetiologies included congenital penile curvature or torsion (n=31), following sexual trauma (n=17), iatrogenic (n=6), venogenic erectile dysfunction (n=5), Peyronie's disease (n=2) and following a pelvic fracture (n= 1). The most common presenting complaints were penile curvature or torsion (n=47), penile instability (n=15) or erectile dysfnnction (n-I6). The surgical outcome was assessed using both objective and subjective measures including aesthetic and functional status of the penis together with patient satisfaction rate, respectively.
RESULTS: After the surgical treatment in 24 patients out of 26 (92.3%) the complete straightening of penis occurred, in 2 (7.7%) cases a residual curvature (<10 °) remained, in 4 patients (15.4%) the shortening of penis (by 1 cm) and in 2 patients (7.7%) a partial reduction of erectile power were observed.
RESULTS: A good surgical result was defined by correction of penile deformity and / or instability with normal sexual function. This was achieved in 55 patients (89%). No improvement or persistent erectile dysfunction was present in 7 patients (11%). In the group of patients who presented with venogenic erectile dysfunction; none reported erectile dysfunction post operatively. Overall, 76% of patients were happy with the surgical outcome.
CONCLUSIONS: Buccal mucosa showed high properties of adaptation and revascularization, good anatomical and functional clinical results by replacement
CONCLUSIONS: Abnormalities of the penile suspensory ligament usually present with complex and unusual penile deformities associated with a variable degree of sexual dysfimction. The diagnosis is made clinically. Surgical repair of the penile suspensory ligament is a simple technique with successful aesthetic and functional outcomes, which result in a high rate of patient satisfaction.
of indurative plaque; so it can be recommended for wide use in clinics for surgical treatment of PD.
859
860
THE PENILE GIRTH E N H A N C E M E N T W I T H AN INVERTED, TUBED DARTOS FLAP
PENIL L E N G T H C H A N G E S IN MEN TREATED W I T H COMBINED HORMONE THERAPY AND RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATIC C A R C I N O M A
Da Silva E.A. Schiavini J., Toledo J., Dami~o R. Haliloglu A., Baltaci S., Yaman O. Rio de Janeiro State University, Urology, Rio de Janeiro, Brazil Ankara University Medical Faculty, Urology, Ankara, Turkey I N T R O D U C T I O N & OBJECTIVES: In selected patients, the penile girth can be a major problem and a reconstructive procedure could be necessary. There is no agreement about the best surgical procedure for penile girth enhancement. Some techniques provide an increased girth but dysmorphic penis. Herein, we described and assessed the results of a new technique to increase penile girth. MATERIAL & METHODS: e performed a penile girth enhancement using an inverted dartos flap in 17 patients (median age 40 years). After a coronal incision through the dartos layer, the penis was completely degloved. Then, the prepuce was de-epithelialized and a dartos flap with a tube shape was created. So, the dartos flap was inverted and wrapped circumferentially around the shaft. Thus, the penile skin was pushed up toward the coronal sulcus, the redundant skin was removed, and margins were sutured. While all patients complained of their penile girth, this was not the indication for surgical treatment. Penile curvature (11 Peyronie's disease, 6 congenital curvatures) was the main reason for surgery. Of 17 patients, three had previous circumcision. All measurements were obtained with the penis in both erect and flaccid state. Acceptance to the body image was assessed by the WHO-QoL BREF questionnaire (question 1I).
RESULTS: The mean follow-up was 14.2 months (ranging from 3to 22 months). The mean girth enhancements of the flaccid and erect penis were 1.54-0.4 cm. and 0.8+0.3 cm., respectively. Patients did not complain of penile discomfort during erection or intercourse. Thirteen (76.5%) patients reported an improvement in the body image and self-esteem after the reconstructive procedure. With regard to the final cosmetic appearance, no patient complained of dysmorphism of their penis. CONCLUSIONS: The inverted dartos flap technique provides an effective but moderate increase of the penile girth. However, this enhancement is more evident in the flaccid state. The patients' satisfaction with the cosmetic result of the penis guarantees further evaluation in large and long-term series with selected patients.
I N T R O D U C T I O N & OBJECTIVES: It is well known that hormone therapy and radiotherapy used in prostate cancer individually have negative effects on penil length. In this study we try evaluate the effects of short term hormone therapy followed by radiotherapy for prostatic carcinoma on the penil length. MATERIAL & METHODS: Locally advanced or localized prostate cancer patients who were not suitable for radical prostatectomy were included in to this study. The follow up time was 9-57 months, (median: 18.1 months). The age was between 50-79 years and the mean age was 68.8 years. This was a prospective study and at the beginning 50 mg bicalutamide was given for 10 days, at the end of this time depot LH-RH analogues [ leuprolide asetate (11.25 rag) or goserelin (10.8 mg)] were administered. LH-RH analouges were administered totally for 3 times every 3 months. At the 8. month of the LH-RH therapy patients received 7000 cGy RT to prostate with linear accelarator (LA). The stretch penil length of the patients were measured and written at the beginning and during the therapy every 3 months by the same doctor (AHH).
RESULTS: The median strecth penil length at the beginning of the therapy was 14.2 cm. At the 3. month it decrease to 13 cm and 8.45% regression from the beginning was calculated. At the 6. month the median penil length was I0.7 cm. The regression rate was calculated as 24.6 % from the beginning and 17.6 % from the first control length. At the 9. month the median penil length was 10.4 cm. This was 26.7 % smaller than the beginning length and 2.8 % smaller than the previous length. At the end of the 12. month the median penil length was 9.6 cm, the regression rate was 32.3% from the beginning and 7.6% after the previous control. CONCLUSIONS: In men treated with combined hormone therapy and radiotherapy for local and locally advanced prostate cancer penil stretch length decreases significantly.
European Urology Supplements 4 (2005) No. 3, pp. 217
858
THE SURGICAL TREATMENT OF PEYRONIE'S DISEASE W I T H THE USE OF FREE AUTO GRAFT OF BUCCAL MUCOSA
S U R G I C A L REPAIR OF THE PENILE SUSPENSORY L I G A M E N T
Shioshvili T., Kakonashvili A.
Institute of Urology, London, United Kingdom
State Medical Academy, Department of Urology, Tbilisi, Georgia I N T R O D U C T I O N & OBJECTIVES: Conservative and palliative methods of treatment in case of Peyronie's disease (PD) are not always effective. The aim of
this work was the evaluation of clinical results of buccal mucosa use for replacement of indurative plaque. MATERIAL & METHODS: Twenty-six patients were under observation. They underwent the following investigations before and periodically within 3 years after the treatment: International Index of Erectile Function, manual
examination of plaque, conventional and power colour Doppler sonography of penis, Peno-Brachiai Index before and its increase after the intracavernous injection of papaverin, measurements of penile length, curvature angle and direction in the phase of rigidity. After stabilization in plaque's development the patients underwent the plaque's excision and its replacement by free auto graft of buccal mucosa.
Li C.Y., Kumar P., Christopher N., Minhas S., Ralph D.
I N T R O D U C T I O N & OBJECTIVES: The suspensory apparatus of the penis consists of the fandiform ligament and the suspensory ligament proper. The penile suspensory ligament serves to support and maintain the erect penis in an upright position during sexual intercourse. This paper assesses the management of patients who presented with an abnormality of the suspensory ligament and subsequently had it repaired. MATERIAL & METHODS: The diagnosis was made clinically, often by the presence of a palpable gap between the symphysis pubis and the penis and / or following a pharmacologically induced erection. The suspensory ligament was approached via a transverse suprapubic incision and the ligament repair performed using an average of four 1/O Ethibond sutures inserted from the midline tunica to the symphysis pubis. At the end of the procedure, an artificial erection was induced to check that the penis was straight and in a functionally desirable position. A total of 62 patients were included, with a mean age of 28 years (range of 14 5 lyrs). The underlying aetiologies included congenital penile curvature or torsion (n=31), following sexual trauma (n=17), iatrogenic (n=6), venogenic erectile dysfunction (n=5), Peyronie's disease (n=2) and following a pelvic fracture (n= 1). The most common presenting complaints were penile curvature or torsion (n=47), penile instability (n=15) or erectile dysfnnction (n-I6). The surgical outcome was assessed using both objective and subjective measures including aesthetic and functional status of the penis together with patient satisfaction rate, respectively.
RESULTS: After the surgical treatment in 24 patients out of 26 (92.3%) the complete straightening of penis occurred, in 2 (7.7%) cases a residual curvature (<10 °) remained, in 4 patients (15.4%) the shortening of penis (by 1 cm) and in 2 patients (7.7%) a partial reduction of erectile power were observed.
RESULTS: A good surgical result was defined by correction of penile deformity and / or instability with normal sexual function. This was achieved in 55 patients (89%). No improvement or persistent erectile dysfunction was present in 7 patients (11%). In the group of patients who presented with venogenic erectile dysfunction; none reported erectile dysfunction post operatively. Overall, 76% of patients were happy with the surgical outcome.
CONCLUSIONS: Buccal mucosa showed high properties of adaptation and revascularization, good anatomical and functional clinical results by replacement
CONCLUSIONS: Abnormalities of the penile suspensory ligament usually present with complex and unusual penile deformities associated with a variable degree of sexual dysfimction. The diagnosis is made clinically. Surgical repair of the penile suspensory ligament is a simple technique with successful aesthetic and functional outcomes, which result in a high rate of patient satisfaction.
of indurative plaque; so it can be recommended for wide use in clinics for surgical treatment of PD.
859
860
THE PENILE GIRTH E N H A N C E M E N T W I T H AN INVERTED, TUBED DARTOS FLAP
PENIL L E N G T H C H A N G E S IN MEN TREATED W I T H COMBINED HORMONE THERAPY AND RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATIC C A R C I N O M A
Da Silva E.A. Schiavini J., Toledo J., Dami~o R. Haliloglu A., Baltaci S., Yaman O. Rio de Janeiro State University, Urology, Rio de Janeiro, Brazil Ankara University Medical Faculty, Urology, Ankara, Turkey I N T R O D U C T I O N & OBJECTIVES: In selected patients, the penile girth can be a major problem and a reconstructive procedure could be necessary. There is no agreement about the best surgical procedure for penile girth enhancement. Some techniques provide an increased girth but dysmorphic penis. Herein, we described and assessed the results of a new technique to increase penile girth. MATERIAL & METHODS: e performed a penile girth enhancement using an inverted dartos flap in 17 patients (median age 40 years). After a coronal incision through the dartos layer, the penis was completely degloved. Then, the prepuce was de-epithelialized and a dartos flap with a tube shape was created. So, the dartos flap was inverted and wrapped circumferentially around the shaft. Thus, the penile skin was pushed up toward the coronal sulcus, the redundant skin was removed, and margins were sutured. While all patients complained of their penile girth, this was not the indication for surgical treatment. Penile curvature (11 Peyronie's disease, 6 congenital curvatures) was the main reason for surgery. Of 17 patients, three had previous circumcision. All measurements were obtained with the penis in both erect and flaccid state. Acceptance to the body image was assessed by the WHO-QoL BREF questionnaire (question 1I).
RESULTS: The mean follow-up was 14.2 months (ranging from 3to 22 months). The mean girth enhancements of the flaccid and erect penis were 1.54-0.4 cm. and 0.8+0.3 cm., respectively. Patients did not complain of penile discomfort during erection or intercourse. Thirteen (76.5%) patients reported an improvement in the body image and self-esteem after the reconstructive procedure. With regard to the final cosmetic appearance, no patient complained of dysmorphism of their penis. CONCLUSIONS: The inverted dartos flap technique provides an effective but moderate increase of the penile girth. However, this enhancement is more evident in the flaccid state. The patients' satisfaction with the cosmetic result of the penis guarantees further evaluation in large and long-term series with selected patients.
I N T R O D U C T I O N & OBJECTIVES: It is well known that hormone therapy and radiotherapy used in prostate cancer individually have negative effects on penil length. In this study we try evaluate the effects of short term hormone therapy followed by radiotherapy for prostatic carcinoma on the penil length. MATERIAL & METHODS: Locally advanced or localized prostate cancer patients who were not suitable for radical prostatectomy were included in to this study. The follow up time was 9-57 months, (median: 18.1 months). The age was between 50-79 years and the mean age was 68.8 years. This was a prospective study and at the beginning 50 mg bicalutamide was given for 10 days, at the end of this time depot LH-RH analogues [ leuprolide asetate (11.25 rag) or goserelin (10.8 mg)] were administered. LH-RH analouges were administered totally for 3 times every 3 months. At the 8. month of the LH-RH therapy patients received 7000 cGy RT to prostate with linear accelarator (LA). The stretch penil length of the patients were measured and written at the beginning and during the therapy every 3 months by the same doctor (AHH).
RESULTS: The median strecth penil length at the beginning of the therapy was 14.2 cm. At the 3. month it decrease to 13 cm and 8.45% regression from the beginning was calculated. At the 6. month the median penil length was I0.7 cm. The regression rate was calculated as 24.6 % from the beginning and 17.6 % from the first control length. At the 9. month the median penil length was 10.4 cm. This was 26.7 % smaller than the beginning length and 2.8 % smaller than the previous length. At the end of the 12. month the median penil length was 9.6 cm, the regression rate was 32.3% from the beginning and 7.6% after the previous control. CONCLUSIONS: In men treated with combined hormone therapy and radiotherapy for local and locally advanced prostate cancer penil stretch length decreases significantly.
European Urology Supplements 4 (2005) No. 3, pp. 217