Wojciech Perdzyński, Marek Adamek Three steps to decrease invasiveness of reconstructive surgery for congenital penile curvature Wojciech Perdzyński, Marek Adamek Centre for Reconstructive Surgery of the Male Genito-Urinary Tract, Damian`s Hospital, Warsaw, Poland

Objective: to avoid degloving (invasive for superficial blood supply and lymphatic vessels) authors used longitudinal skin and tunica dartos incision (over convex penile surface) and partial protrusion of penile shaft through the skin. M&M:This attitude was used in 99 patients with ventral curvature,in13 patients with dorsal and 53 with lateral curvature. Penile protrusion was used in ventral curvature. Objective:to decrease invasiveness to neurovascular bundles (NVBs) authors separate them from tunica albuginea only locally in a shape of triangle or trapezium. M&M: This technique was used in 99 patients with ventral curvature.

M&M: This technique was used in 186 patients from 2006 until Objective: to decrease invasiveness for tunica albuginea and for cavernous vessels new technique was developed in which corpora cavernosa are not opened. Only elliptic fragments of external layer of tunica are excised and both layers of tunica are sutured over invaginated internal layer (first presented at Joint Meeting of ESSM and ISSM held in Bruxelles (Belgium) in 2008). M&M: This technique was used in 186 patients from 2006 until 2016. Mean age 23 years. Postoperative follow-up 6 months – 10 years. Degree of curvature from 30 to 90 degrees (mean 60). Patients with ventral curvature - 69, with dorsal -18, with lateral 53.

Conclusions: Results: In all patients longitudinal skin incision enabled penile straightening. In no patient chronic postoperative oedema was observed. Disorders of superficial sensation on the glans or erectile dysfunction were not detected in any patient. Penile straightening was achieved in 180 patients (96,7%). In 4 patients (2,2%) recurrence of curvature about 30 degrees degrees was detected (primary curvature in these patients was from 80 and 90 degrees) and reoperation was done. In two patients (1,1%) with remaining curvature up to 20 degrees and good functional result (patient`s opinion) there was no need for further treatment. Conclusions: Longitudinal skin and tunica dartos incision on convex penile surface enables good access to Buck`s fascia and tunica albuginea which allows to avoid penile degloving and its possible complications. Another value of this access is preservation of a foreskin. Elevation of dorsal NVBs from tunica albuginea done only on limited surface - necessary for tunical reconstruction - in the shape of a triangle or trapezium decrease possibility of dorsal nerves/vessels damage. Excision of elliptic fragment of external layer of tunica albuginea with subsequent invagination of internal layer by the sutures gives good short and long-term results. Our method excludes the need for using a tourniquet during reconstruction because corpora cavernosa are not opened. This diminish potential risk of complications, especially intra- and postoperative bleeding.