Method for correcting rotating penile deformation

FIELD: medicine, urology.

SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.

EFFECT: higher efficiency of correction.

3 dwg, 1 ex

 

The invention relates to medicine, namely to urology and andrology, and can be used for correction of rotational deformity of the penis.

There is a method of correction of rotational deformity of the penis (.Belgrano, G.Lignori, .Trombetta, S.Siracusano. Correction of complex penile deformations by modifications Nesbit procedure asymmetric tunica albugenia excision. European Urology. - 2000. No. 38(2) - R-172), involving the cutting and excision of the ellipsoid plots on the sides of the tunica after intraoperative manual derotation and then suturing the edges of the defect, taken as a prototype. The drawback of this method can be considered as the need for excision of areas of the tunica that, due to violations of the fibrous skeleton of the penis is a prerequisite for the formation of long-term new or residual deformation.

The technical result of the invention is to reduce risk in the postoperative period of a new or residual deformation of the penis, as well as simplification of the method.

The technical result is achieved by applying cuts on the surface layer of the tunica and the subsequent imposition of corrective deformation seams offset Mykola needle in the direction opposite to the shift direction of the lower edge relative to the perpendicular axis of the notches, the number of notches compute p the formula: K=N/n, where: K - number of notches, N is the total angle of the initial rotation, n - derotation angle reached after suturing the first couple of notches.

Figure 1 shows the appearance of the penis coated with notches and ligatures from derotation, figure 2 - view of the penis coated with notches and ligatures with the contralateral hand, figure 3 - view of a notch with ligatures.

The proposed method of correction of rotational deformity of the penis as follows: after a circular skin incision in the coronary sulcus and moving it to the root of the penis against medical erection on the lateral surfaces of the cavernous bodies symmetrically on both sides produce a notch length of 15-20 mm at an angle of 45°cleaving only the surface layer of the tunica (figure 1 and 2). Then make manual derotation penis and hold it in this position. On the edge of the dissected layers of the tunica in the field of notches impose 2-3 seam of preservision suture material. At offset cavernous bodies on the side derotation bottom edge of the tunica is shifted down and to the back, top - up and anteriorly, and on the contralateral side of the bottom edge is shifted downward and anteriorly, and the top - up and to the back. For maximum effect Vicol needle is offset by 3 mm in the direction reverse the shift direction of the lower edge relative to the perpendicular axis of the notch (figure 3).

After suturing the first couple of notches measure the angle achieved derotation (n). The required number of notches (K) calculated by dividing the total initial rotation (N) on the corner derotation after suturing the first couple of notches by the formula

K=N/n,

where N and n - value, expressed in degrees.

During the operation, perform a careful hemostasis. After the correction of rotational deformation of the skin is shifted to the original position, skin impose nodal cathalogue seams, circular spirit and sterile dressing. It is advisable to keep the wound narrow rubber drainage for 2-3 days.

Above described method operated on two patients.

Example: the Patient, Doctor, 24 (no history 116408). Diagnosis: Congenital rotary (85° right) deformation of the penis in the distal one-third without erectile dysfunction. 01.02.2002 corrected rotational deformities of the penis: under epidural anesthesia after exposure of the tunica and manual derotation background drug erection (Sol. Papaverini hydrohcloridi 2% - 1,0) made the first pair of notches in the distal third of the penis. The derotation angle was 30°. According to the proposed formula To=85°/30°=2,83≈3. After blending in p is Arsenalna additional two pairs of notches with the imposition of corrective welds achieved adequate denotate. Closure of surgical wounds, leaving rubber drainage. Rubber drain was removed on the third day of the postoperative period. Morning erections resumed on the second day of the postoperative period. Sutures were removed on the 10th day of the postoperative period. The cosmetic result is excellent, the patient is satisfied.

Method of correction of rotational deformity of the penis, including the impact on the tunica albuginea and the imposition of corrective deformation seams on the medicated erection, characterized in that the lateral surfaces of the cavernous bodies symmetrically on both sides produce a notch of the surface layer of the tunica, produce manual derotation, however, on the derotation bottom edge of the notch is shifted down and to the back, top - up and anteriorly, and on the contralateral side of the bottom edge is shifted downward and anteriorly, and the top - up and back, then after manual derotation of the penis on the edge of the dissected layers of the tunica in the field of notches suture by moving Vicol needle in the direction opposite to the shift direction of the lower edge relative to the perpendicular axis of the notches, the number of notches is calculated by the formula

K=N/n,

where K is the required number of notches,

N is the total angle of the initial rotation,

n - derotation angle, dostignutoi after suturing the first couple of notches.



 

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