Treatment of congenital and acquired penile curvature with the Essed plication method: Own experience and review of the literature

Purpose: Penile deviation, either congenital or due to Peyronie's disease, can be corrected by simple plication of the tunica albuginea as described b y Essed. Our own experience with this method is presented and compared to t he data of both the Essed and the Nesbit procedure as reported in the liter ature. Materials and methods: From 1991 to 1996, the Essed procedure was performed in 61 patients. 65.6% (n = 40) had congenital deviation and 34.4% (n = 21) suffered from secondary deviation due to Peyronie's disease. Non-absorbabl e inverting interrupted sutures were used and follow-up was done either dur ing routine clinical follow-up or by standardized questionnaire. Patient ag e ranged from 15 to 65 years (mean 31.3) and the mean follow-up time was 39 .8 months (12-75). Preoperative penile deviation was between 20 degrees and 90 degrees (mean 47.4 degrees). Only 47.5% of the patients with congenital and 10% with Peyronie's disease were able to perform sexual intercourse at all. Results: 18 patients (29.5%) had a recurrent deviation following surgery. T his failure rate was higher in the patient group with Peyronie's disease (4 2.9%) than in the group with congenital deformation (22.5%). Postoperativel y, 2 patients (3.3%) reported de novo erectile dysfunction. 20 patients (32 .8%) complained of persistent discomfort or pain at the area of the still p alpable plication sutures. 45.9% stated penile shortening after surgery, bu t only 21.3% felt bothered. Conclusions: Our results are in accordance with the literature, showing a h igher recurrence rate of deviation than the Nesbit procedure. Furthermore, one-third of all patients complained of discomfort from the non-absorbable sutures. For both methods, the risk of recurrent disease is higher in patie nts with Peyronie's disease, and, in both techniques, an equally low incide nce of erectile dysfunction is evident. Therefore, the Nesbit procedure see ms to be superior.