Horizontal Plication and Reduction Corporoplasty for Penile Girth Discrepancy (Christmas Tree Deformity)

Authors: Ramzy Burns, Melissa Egert, Mary Soyster, Andre Alabd, Helen Bernie

Key Words: Peyronie’s, Horizontal Plication

This video displays a very rare form of Peyronie’s disease leading to a significant girth discrepancy. The patient was unable to have penetrative intercourse due to the girth. This deformity noted as a “Christmas Tree Deformity” as well as the surgical correction, have only been described in the literature once beforehand. The video displays the utilization of horizontal plication sutures to correct the girth discrepancy with significant improvement observed. The patient had an uncomplicated recovery and is able to now have successful penetrative intercourse.

Acknowledgements: None

Disclosures: None

References:

1. Ferandez-Crespo R, Buscaino K, Parker J, Carrion R. A New Approach for Penile Girth Discrepancy: Modified Plication and Reduction Corporoplasty. AUA News. May 2021. 

The “Kiel Knots” Technique for the Treatment of Congenital and Acquired Penile Curvature

Authors: Daniar K Osmonov, Ahmed M. Ragheb

Key Words: Kiel, knots, penile, congenital, curvature, Peyronie’s

Penile curvature is not only a cosmetic issue, but can also cause severe functional and psychological problems for the affected men and their partners. There are many surgical techniques for correction ranging from the least invasive as plication to the more invasive as incision or excision and grafting. We propose our “Kiel Knots” technique, based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques for the correction of both congenital and acquired penile curvatures. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach while highlighting the added advantages of our technique.

Disclosures: This video was not financially supported. The authors have nothing to disclose.

References:

1. Essed E, Schroeder FH. New surgical treatment for Peyronie disease. Urology. 1985 Jun;25(6):582-7. doi: 10.1016/0090-4295(85)90285-7. PMID: 4012950.
2. Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol. 2002 May;167(5):2066-9. PMID: 11956440.

Traumatic Tri-Corporal Penile Fracture, A Step-by-Step Surgical Repair

Authors: Orry, Marciano BA; Manish, Pathuri BA; Kristina, Gam MD; Omer, Raheem MD

Key Words: penile fracture, penile repair

Penile fracture can occur after forced flexion of the erect penis, resulting in rupture of the tunica albuginea. These traumatic injuries require urgent urologic evaluation and prompt diagnosis, with surgical repair being the standard of care. This video outlines the presentation, surgical indications, surgical repair, and post-operative course of a penile fracture repair.

Acknowledgements: None

Disclosures: None

References:

1. Morey AF, Zhao LC. Genital and lower urinary tract trauma. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell‐Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. p. 2379‐92. 
2. De Rose AF, Giglio M, Carmignani G. Traumatic rupture of the corpora cavernosa: new physiopathologic acquisitions. Urology. 2001 Feb;57(2):319-22. 
3. Bitsch M, Kromann-Andersen B, Schou J, Sjøntoft E. The elasticity and the tensile strength of tunica albuginea of the corpora cavernosa. J Urol. 1990 Mar;143(3):642-5. 
4. Amer T, Wilson R, Chlosta P, AlBuheissi S, Qazi H, Fraser M, Aboumarzouk OM. Penile Fracture: A Meta-Analysis. Urol Int. 2016;96(3):315-29. 
5. Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev. 2018 Apr;6(2):272-278.
6. Rodriguez D, Li K, Apoj M, Munarriz R. Epidemiology of Penile Fractures in United States Emergency Departments: Access to Care Disparities May Lead to Suboptimal Outcomes. J Sex Med. 2019 Feb;16(2):248-256.
7. Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021 Jan;205(1):30-35. 
8. Metzler IS, Reed-Maldonado AB, Lue TF. Suspected penile fracture: to operate or not to operate? Transl Androl Urol. 2017 Oct;6(5):981-986

Double Distal Corporal Anchoring Stitch For Lateral Penile Implant Cylinder Extrusion: A Step-by-Step Surgical Technique

Authors: Omer A. Raheem, Senthooran Kalidoss, Alfredo Suarez-Sarmiento, Paul E. Perito

Key Words: Double fixation stitch, surgical technique, impending lateral extrusion, penile implant, surgical revision procedure

This video covers the surgical technique for the correction and fixation of laterally extruded distal inflatable penile prosthesis (IPP) implant cylinders from the surgical capsule they are sealed within. This patient, with a 20-year history of diabetes, presented 3 years post IPP implantation with a lateral extrusion of one cylinder tip. This double distal fixation stitch technique, when performed after a corporoplasty and capsulotomy, anchors the distal cylinder tip more securely in place medially under the glans penis by creating a bridge between sutures. The fibrotic reactions created by the two sutures under the skin also help fixate the extruded cylinder to the proper position behind the glans. We demonstrate a step-by-step technique to use this double fixation stitch to secure extruded distal cylinders of an IPP implant placement.

Acknowledgements: None

Disclosures: The authors have no disclosures.

References:

1. Antonini, G., Busetto, G. M., Del Giudice, F., Ferro, M., Chung, B. I., Conti, S. L., Suarez Sarmiento, A., Pacchiarotti, A., De Berardinis, E., & Perito, P. E. (2017). Distal corporal anchoring stitch: A technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis. The Journal of Sexual Medicine, 14(6), 767–773. https://doi.org/10.1016/j.jsxm.2017.04.669 
2. Clavell-Hernández J. (2021). Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sexual medicine, 9(3), 100379. https://doi.org/10.1016/j.esxm.2021.100379
3. Mulcahy, John J. (1999). Distal corporoplasty for lateral extrusion of penile prosthesis cylinders. Journal of Urology, 161(1), 193–195. https://doi.org/10.1016/s0022-5347(01)62094-9 
4. Tran, V. Q., Lesser, T. F., Kim, D. H., & Aboseif, S. R. (2008). Penile corporeal reconstruction during difficult placement of a penile prosthesis. Advances in urology, 2008, 370947. https://doi.org/10.1155/2008/370947

Royalty-free music acknowledgement (as requested by artist):

Sad Piano No Copyright Music | Children by Alex-Productions |https://youtu.be/jzYEToxsEgw
Music promoted by https://onsound.eu/