title: Tunica albuginea underlap--a new modification of the Nesbit procedure: description of the technique and preliminary results.
abstract: BACKGROUND
  We describe a new surgical technique for the treatment of penile curvature that combines features of the Nesbit procedure with features of tunical plication. U-shaped flaps of tunica albuginea are freed from the corpus cavernosum. The flaps are brought under the remaining tunica albuginea and are fixated with single absorbable sutures. As the defects of the tunica are sealed tightly and with high tensile strength by double layers of tunica albuginea, correction of the abnormal curvature is achieved.
  
  
  OBJECTIVE
  To present our experience with a new surgical technique for the treatment of penile curvature.
  
  
  METHODS
  Between 2008 and 2011, 50 patients underwent the underlap technique because of Peyronie's disease (37) or congenital penile deviation (13) in a single center.
  
  
  METHODS
  Preoperative and postoperative evaluation included the Erection Hardness Score (EHS) and the Symptom Score for Induratio penis plastica (IPP-SSC), a symptom score for penile deviation that was based on a consensus of regional andrologists. Clinical data concerning the early postoperative outcome were analyzed retrospectively using standardized items.
  
  
  RESULTS
  Mean age ± standard deviation was 59.7 ± 8.4 years for patients with Peyronie's disease and 34.1 ± 7.8 years for patients with congenital penile deviation. The mean follow-up period was 27 months. The major complication rate was 4%, overall satisfaction 86%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 6%. The mean difference of preoperative and postoperative IPP-SSC was 8.1 (95% confidence interval [CI] 7.24 to 8.96). The mean difference of preoperative and postoperative EHC was -0.03 (95% CI -0.16 to 0.09).
  
  
  CONCLUSIONS
  Preliminary results obtained with the underlap technique showed promising outcome with minimal morbidity. The new technique might have three main advantages: more flexible intraoperative correctability of the curvature, tighter sealing of the tunical defects, and greater tensile strength of the plications.
authors.affiliation: Andrologie Centrum München, München, Germany. j.u.schwarzer@gmx.de
authors.forename: J Ullrich
authors.initials: JU
authors.lastname: Schwarzer
authors.forename: Heiko
authors.initials: H
authors.lastname: Steinfatt
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000151:congenital / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques