title: Tunica albuginea reefing: a novel technique for the treatment of erectile dysfunction.
abstract: BACKGROUND
  "Tunica albuginea (TA) reefing" is a modification of Shafik's "TA overlapping" operation. Both techniques are based on the fact that in venogenic erectile dysfunction patients, the TA exhibits degenerative and atrophic collagen and elastic fibers causing its subluxation and flabbiness. This had led to loss of the veno-occlusive mechanism of the TA and venous leakage during erection.
  
  
  OBJECTIVE
  Reefing of the redundant tissue by bilateral excision of an ellipse of the TA provides a more effective correction of the TA and achieves a good support of the corpora cavernosa during tumescence.
  
  
  METHODS
  The study included 24 patients with a mean age of 33.5 ± 1.7 SD years. Intracorporal pressure was measured preoperatively and postoperatively. After penile degloving, an ellipse was excised from both lateral aspects of the penile shaft, extending from the glans penis to its root, and the two edges of each wound were reefed by continuous Dexon suture.
  
  
  RESULTS
  The TA ellipses were taken as biopsies and revealed degenerative changes when stained with hematoxylin and eosin and Masson's trichrome stain. Postoperatively, there was an intracorporal pressure increase (p < .01) in 20 out of 24 patients of the study and a decrease in 4 out of 24. Six months after operation, the patients showed significantly (p < .01) improved scores for the domain of erectile function over the preoperative scores.
  
  
  CONCLUSIONS
  The reefing operation corrects the TA flabbiness to a greater extent, lends more support to corporal tissue, and improves the veno-occlusive mechanism.
authors.affiliation: Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt. shafik@ahmedshafik.com
authors.forename: Olfat
authors.initials: O
authors.lastname: el-Sibai
authors.forename: Ali A
authors.initials: AA
authors.lastname: Shafik
authors.forename: Ismail A
authors.initials: IA
authors.lastname: Shafik
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D018783:Impotence, Vasculogenic / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010410:Penile Erection; D010413:Penis / Q000098:blood supply / Q000601:surgery*