Pdf penis enlargement ventral and dorsal combined technique
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The NCBI web site requires JavaScript to function. However, they do provide certain advantages, both theoretic and real, over competing procedures such as grafting. Depending on the technique, plication procedures have minimal risk of de novo erectile dysfunction, minimal risk of injury to the dorsal neurovascular bundle, and may be used for a variety of angulation deformities, including multiplanar curvature and severe degrees of curvature.
A variety of incisions may be used, including the classic circumcision with degloving but also ventral raphe, dorsal penile inversion, and pdf penis enlargement ventral and dorsal combined technique. These may be helpful in preventing postoperative morbidity and in sparing the prepuce if desired. Plication may also be combined with procedures such as penile prosthesis for correction of residual curvature.
Lastly, despite its complications, plication techniques are very well tolerated, are relatively simple to perform and result in the very high satisfaction rates. These scars, referred to as plaques, can present as a protean variety of penile deformities. Patients may present with penile mass, pain, or deformity; deformity may preclude coitus.
In many men, PD is accompanied by lack of erectile rigidity. It is commonly found in men between the ages of 40 and 70 years, although it can affect younger patients as well [ LaRochelle and Levine, ; Tal et al. The natural history of PD includes active and stable phases.
Although the natural history of PD is not completely understood, the commonly held view that PD often spontaneously regresses has been challenged by recent studies [ LaRochelle and Levine, ]. Many patients only require reassurance, while more invasive treatments such as surgery are infrequently necessary. For those who do need therapy, there are both medical and surgical options. In this chapter, we will exclusively focus on plication as a surgical approach to the management of PD and other causes of penile curvature, and will attempt to review the more recent literature regarding outcomes and complications of plication procedures.
In addition to PD, curvature of the penis may be a congenital or an acquired deformity. Congenital deformities include chordee with or without associated hypospadias and congenital curvature. Acquired curvature can be a result of overzealous circumcision, other penile surgeries, or trauma to the penis, such as buckling trauma during intercourse or overt penile fractures. PD is one form of an acquired curvature of the penis, and is not considered to be congenital.
Appreciation of the anatomy of the tunica albuginea and the corpora is important in understanding the etiology and the potential treatments of PD.
The tunica albuginea is bilaminar, with an outer longitudinal layer and an inner circular layer. The outer longitudinal layer attenuates in the ventral midline, and thus the tunica is monolaminar at that point. It is also thin at the lateral aspects of the corpora. It is thickest on the dorsum and at the ventrum adjacent to the corpus spongiosum. The tunica albuginea varies in thickness from 1. Supporting fibers from the incomplete septum of the corpora are attached to the inner layer of the tunica along the dorsal and ventral midlines.
Plaques occur in the tunica albuginea at the site of the septal attachments. Despite the tunica being thickest in the region, most scars of PD develop on the dorsal aspect of the corpora [ Brock et al.
The etiology of PD is controversial. The pdf penis enlargement ventral and dorsal combined technique widely accepted theory is that an injury to the penis, causing a buckling or tearing of the tunica albuginea, results in the disruptions of blood vessels, leading to an inflammatory response with subsequent remodeling of the connective tissue into fibrosis.
The resultant deformity, caused by fibrotic inelastic tunica, predisposes the area to further injury. Treatment for PD is aimed at achieving an erection that allows for successful and pain-free coitus for both patient and partner. The decision on how best to approach treatment of PD is often challenging. A candid discussion with the patient and his partner is a necessity to elucidate acceptability of current and potential deformity, goals of treatment if medical or surgical options are entertained, complications associated with treatment, and realistic expectations of outcomes.
The decision to actively treat is typically based on multiple factors, including patient age, degree of deformity, associated erectile dysfunction ED and its onset in pdf penis enlargement ventral and dorsal combined technique to development of PD, degree of pain with erection or intercourse, partner satisfaction or pain with intercourse, inability to penetrate, cosmetic displeasure, and the phase of plaque maturation.
That being said, it is essential to take a thorough medical and sexual history and to perform a complete physical exam, including objective measurements of penile curvature at maximal rigidity, as it has been well documented that many patients tend to overestimate the degree of their curvature [ Bacal et al.
Fortunately, not all patients need treatment because some will maintain good erectile function and only have mild curvature that does not preclude coitus. These patients should receive reassurance and expectant management. For those with more debilitating forms of the disease, many active treatment options exist, including medical and surgical therapies. Surgical therapy is reserved for only patients with deformity that precludes intercourse or is associated with significant ED.
Thus, the goal of surgical therapy is to restore an erection that is sufficiently straight and rigid for coitus. In an effort to minimize the risk of postoperative recurrence, surgery is delayed in these patients until the plaque has matured and the curvature has stabilized. Surgical therapy can be classified into three main categories: This nomenclature can be somewhat misleading, as not all patients undergoing tunical shortening procedures notice postprocedural loss of penile length, and likewise, most patients undergoing tunical lengthening procedures do not enjoy a longer phallus post procedurally.
A new approach in hypospadias repair | SpringerLink
Update on plication procedures for Peyronie’s disease and other penile deformities
Read more inside details about the titan gel pretty Surgical therapy is reserved for only patients with deformity that precludes intercourse or is associated with significant ED. Categories does male enhancements really work how to grow long penis penis quizzes, trivia, questions and answers how to get a bigger penis naturally titan gel in pakistan triluma. In this chapter, we will exclusively focus on plication as a surgical approach to the management of PD and other causes of penile curvature, and will attempt to review the more recent enlargemet regarding outcomes and complications of plication procedures. The use of various grafts and flaps plays a critical role in the successful epnis management of urethral stricture disease. Plication may also be combined with procedures such as penile prosthesis for correction of eblargement curvature. In an effort to minimize the risk of postoperative recurrence, surgery is delayed in these patients until the plaque has matured and the curvature has stabilized. Furthermore, they involve a circumcision type incision with minimal disfigurement of the penis.
The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease
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