title: Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results.
abstract: OBJECTIVE
  A Nesbit or plication procedure for correcting penile deformities is associated with penile shortening, especially in patients with excessive curvature and/or rotation. On the other hand, grafting procedures are associated with poor postoperative results due to graft shrinkage and veno-occlusive dysfunction. To minimize penile shortening and preserve potency we describe a new surgical technique combining the Nesbit procedure with tunica albuginea free grafting. Long-term functional results and patient satisfaction are reported.
  
  
  METHODS
  We treated 17 potent patients with a mean age plus or minus standard deviation of 46.1 +/- 14.5 years, including 4 with congenital penile deviation and 13 with stabilized Peyronie's disease. Opposite the point of maximal curvature a typical Nesbit procedure was performed. The excised tunica albuginea segment consequently served as a free graft. A symmetrical incision was made at the opposite site and the preserved elliptical tunica albuginea graft was placed in the defect. Further elliptical excisions and grafting followed as needed to correct the deformity.
  
  
  RESULTS
  At a mean followup of 39.5 +/- 13.7 months (range 18 to 62) all patients reported penile straightening and functional erection, while ultrasonography of the corpora cavernosa revealed no changes in graft ultrastructure. There was penile shortening in 8 patients (47%) but only 2 (11.7%) considered it significant. All patients with a minimum 2-year followup were positive in regard to recommending the operation to others or repeating it if necessary.
  
  
  CONCLUSIONS
  The newly described technique may be considered as a treatment option in patients with excessive penile curvature since shortening of the penile shaft is eliminated by 50% compared with the result of the Nesbit procedure. Tunica albuginea seems to be an appropriate grafting material since it prevents postoperative corporeal veno-occlusive dysfunction.
authors.affiliation: Department of Urology and Center for Sexual and Reproductive Health, Aristole University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Hatzichristou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Hatzimouratidis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Apostolidis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Tzortzis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Bekos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Ioannidis
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male