Clinical and penile Doppler outcomes using a modified, tourniquet free, Nesbit plication for severe Peyronie's disease.

Penile curvature (PC) can be surgically corrected by plication techniques or Nesbit corporoplasty. These shortening techniques can be complicated by post-operative: penile shortening, recurrent PC, palpable suture knots and erectile dysfunction. Furthermore, Nesbit procedures require the use of a penile tourniquet to avoid intraoperative bleeding. This observational study aims to assess the results of Nesbit modified corporoplasty, avoiding intraoperative use of tourniquet without risk of bleeding. The objective is to reduce penile ischemic anatomical and functional damages such as long-term erectile dysfunction.

Between January 2010 and March 2019, a total of 64 patients with congenital penile curvature (CPC) and Peyronie's disease (PD) underwent surgical correction with a Nesbit modified technique first time described by Rolle et al., with minimal technical differences. The operation notes were retrospectively reviewed. In particular, we evaluated pre- and post-operative erectile functions using IIEF-5 score, penile Doppler ultrasonography and overall patient satisfaction.

During operations, no intraoperative bleeding was noted, and no short-term complications such as hematomas or neurovascular bundle lesions were reported. At 6 months, no palpable subcutaneous indurations and no sensory change were detected. Post-operative penile shortening was reported in 38 (59.4%) patients (mean 0.83±0.79 cm), but it did not influence the high overall satisfaction rate of 91.4%. Only 2 patients reported a slightly partial recurrence of curvature (<15%) with no need for a redo surgery. Mean IIEF-5 score increased from 17.1±5.2 to 20.8±3.9 at 6 months and 21.8±3.4 at 12 months (P<0.001 in both cases). Mean PSV also significantly increased at the end of follow-up (28.5±6.1 at baseline vs. 31.0±7.1 at 12 months, P=0.03).

Considering the optimal results in terms of erectile functions increasing and absence of PC recurrence (>15°), we think that Nesbit modified corporoplasty without tourniquet application during reconstruction is a safe and effective surgical procedure for all kind of shortening corporoplasty to reduce the time of penile ischemia, preventing even serious consequences for the normal physiology of erection.

Translational andrology and urology. 2021 Jul [Epub]

Vincenzo Maria Altieri, Francesco Greco, Rocca Carmela Lisanti, Barbara Altieri, Francesco Esperto, Luca Cindolo, Roberto Castellucci, Pier Andrea Della Camera, Giuseppe Massimo Sangiorgi, Vittore Verratti

Department of Urology, Policlinico di Monza, Monza., Urologic Clinic, Centro Salute Uomo, Bergamo, Italy., Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany., Department of Urology, Campus Biomedico, University of Rome, Rome, Italy., Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy., Department of Urology, SS. Annunziata Hospital, ASL 2 Abruzzo Chieti, Italy., Department of Urology, University of Florence, Careggi University Hospital, Florence, Italy., Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy., Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy.

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