Introduction The Nesbit plication with partial thickness shaving is an accepted and effective technique for the correction of congenital curvature of the penis. We report an unusual case of corpus cavernosum herniation after tunical shaving and plication and its surgical treatment. Case Presentation and Management A 24-year-old man who had previously undergone partial thickness tunical shaving and plication with absorbable suture was referred for evaluation of a mass at the base of the right corpus cavernosum at the level of the previous operation, present at the flaccid state of the penis and increasing during erections, which he had first noticed one month after surgery. The mass had subsequently enlarged to involve a third of the right corpus cavernosum. With pharmacological erection, we noticed a painless bulging of the proximal third of the right corpus cavernosum and palpation revealed a reduced hardness in such area. At the operation, there was a visible abnormality in the flaccid state. After artificial erection the mass was enlarged with decreased thickness of the albuginea in this region. The edges of the attenuated tunica were stitched together with interrupted sutures of 2-0 Maxon, to give more strength to the albuginea and a dermal patch was approximated to the perimeter of the defect with a 4-0 Dexon, to correct the indentation caused by the stitches. After twelve months the cosmetic results are satisfactory with no recurrence of the deformity. Discussion This unusual case represented a diagnostic and therapeutic dilemma. We decided not to resect the area of attenuated tunica but just to stitch together its edges and the aim was to give more strength to the albuginea avoiding to incise it. We, then, approximated a dermal patch to the perimeter of the defect, just above the albuginea to correct the indentation caused by the stitches. To our knowledge, we report the first case of hernia after tunical shaving and plication. We can only speculate on the causes of the complication presented. We suspect that the original absorbable sutures of the Nesbit had either cut out or lost their tension prematurely during an erection and this allowed the aneurism to form overcoming the resistance of the partial thickness albuginea.

CORPOREAL HERNIATION AFTER NESBIT PLICATION WITHPARTIAL THICKNESS SHAVING IN CONGENITAL PENILECURVATURE AND ITS MANAGEMENT / G. Morelli; A. Minervini; G. Salinitri; N. Dinelli; M. De Maria; R. Minervini; C. Selli. - STAMPA. - Atti V International Congress Therapy in Andrology:(2003), pp. 140-140. (Intervento presentato al convegno Fifth International Congress Therapy in Andrology tenutosi a pisa nel 24-27 marzo).

CORPOREAL HERNIATION AFTER NESBIT PLICATION WITHPARTIAL THICKNESS SHAVING IN CONGENITAL PENILECURVATURE AND ITS MANAGEMENT

MINERVINI, ANDREA;
2003

Abstract

Introduction The Nesbit plication with partial thickness shaving is an accepted and effective technique for the correction of congenital curvature of the penis. We report an unusual case of corpus cavernosum herniation after tunical shaving and plication and its surgical treatment. Case Presentation and Management A 24-year-old man who had previously undergone partial thickness tunical shaving and plication with absorbable suture was referred for evaluation of a mass at the base of the right corpus cavernosum at the level of the previous operation, present at the flaccid state of the penis and increasing during erections, which he had first noticed one month after surgery. The mass had subsequently enlarged to involve a third of the right corpus cavernosum. With pharmacological erection, we noticed a painless bulging of the proximal third of the right corpus cavernosum and palpation revealed a reduced hardness in such area. At the operation, there was a visible abnormality in the flaccid state. After artificial erection the mass was enlarged with decreased thickness of the albuginea in this region. The edges of the attenuated tunica were stitched together with interrupted sutures of 2-0 Maxon, to give more strength to the albuginea and a dermal patch was approximated to the perimeter of the defect with a 4-0 Dexon, to correct the indentation caused by the stitches. After twelve months the cosmetic results are satisfactory with no recurrence of the deformity. Discussion This unusual case represented a diagnostic and therapeutic dilemma. We decided not to resect the area of attenuated tunica but just to stitch together its edges and the aim was to give more strength to the albuginea avoiding to incise it. We, then, approximated a dermal patch to the perimeter of the defect, just above the albuginea to correct the indentation caused by the stitches. To our knowledge, we report the first case of hernia after tunical shaving and plication. We can only speculate on the causes of the complication presented. We suspect that the original absorbable sutures of the Nesbit had either cut out or lost their tension prematurely during an erection and this allowed the aneurism to form overcoming the resistance of the partial thickness albuginea.
2003
Atti V International Congress Therapy in Andrology
Fifth International Congress Therapy in Andrology
pisa
G. Morelli; A. Minervini; G. Salinitri; N. Dinelli; M. De Maria; R. Minervini; C. Selli
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/683951
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