1.- congenital penile curvature (CPC) is caused by an asymmetric embryonic development of the corpora cavernosa. This curve of the penis during erection is usually ventral, and can be so severe (even more than 90 degrees) that sex can be very difficult or even impossible.
2. It is a relatively common disease in the Andrology office. According to some authors, a certain degree of penile curvature can be observed in up to 4 out of 10 men. In more severe cases, it can seriously affect sex and can cause psychological concern. It will require special handling by the specialist and a sensitive approach.
3. Two main types of congenital curvature of the phallus can be found, depending on the development of the corpus spongiosum: those associated with a normal urethra, and those with a hypoplastic or atrophic urethra.
4. Patients who suffer often come to the office when they start being sexually active, that is to say, in the second or third decade of life. Only severe cases of penile curvature, without hypospadias can be diagnosed in childhood. Patients usually complain about the curvature of the erect penis, which is often ventral, sometimes lateral, and rarely may be dorsal or combine. Dorsal curvature is extremely rare, except when associated with penile torsion.
5. Surgery is the only treatment option for this condition. It can be done anytime in adulthood. However, early treatment (14-18 years) could prevent psychological impact.
6. Two main surgical options available for correcting penile curvature:
- Shorten the longest side with resections, incisions or plication.
- Extending the shorter side of the erect penis with a graft.
7. Three techniques most commonly used to repair simple curves are the original Nesbit procedure, modified Nesbit procedure and plication. In patients with penile curvature, the Nesbit technique offers somewhat better results than the simple plication techniques. However, this procedure always involves some shortening of the penis.
8. Two new techniques can be applied more recently trying to preserve more length in the penis. On the one hand the rotation Technique of the corpora cavernosa, based on a dorsal longitudinal incision on the dorsal side of each corpus cavernosum and a double suture of the internal and external parts of the incision. This innovative technique reduces shortening effects of traditional techniques with the same curvature correction and very good results.
The second technique is based on the Transposition of tunica albuginea. This is a new technique for the penis with lateral curvature: corporoplasty by transposition of autologous free graft of corpora cavernosa. The transposition of a patch on the tunica albuginea of the corpora cavernosa from the convex side to the concave side is a promising technique. Recently described by our group (Dr. Cruz 2010), this technique aims to reduce penile shortening by transposing 1-2 small grafts from the longest side of the tunica albuginea to the shortest.