RU2234257C2 - Method for surgical correction oferectile deformation in case of peyronie's disease - Google Patents

Abstract

FIELD: medicine, andrology.

SUBSTANCE: one should carry out phalloskeletonization, isolate and dissect the parts of fibrosis of albuginea tunica, cover the defect with a transplant as vascularized section of the upper third of major subcutaneous vein. Moreover, venous parts should be applied under penis skin with its intima being inside. The method enables to exclude erectile deformation and dysfunction in case of Peyronie's disease.

EFFECT: higher efficiency of surgical correction.

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Description

The present invention relates to medicine, in particular to andrology, and may find application in the treatment of the male reproductive system.

Among the diseases of the male reproductive system, Peyronie's disease occupies one of the leading places, despite its insignificant prevalence from 0.3 to 1%.

Peyronie’s disease, or fibroplastic induction of the penis, is characterized by the formation of tight plaques in the protein coat of the corpora cavernosa, leading to the appearance of painful erections, curvature of the penis during erection, and a decrease in its rigidity, which leads to sexual dissatisfaction and deep psychological trauma.

Peyronie's disease most often affects men aged 40-60 years, the average age is 53 years, but sometimes it occurs in men of an older or younger age.

The etiology and pathogenesis of this disease is still not clear in many respects.

The most common symptoms of Peyronie's disease are palpable plaques - 78-100%, penile curvature - 52-100%, painful erections 70%. The size of the plaques ranges from a few millimeters to several centimeters and averages 1.5-2 centimeters. Depending on the localization of the plaque, dorsal, ventral and lateral curvature of the penis are distinguished.

Known oral therapy with tamoxifen [1], colchicine [2]. Described peroral and local use of steroids [3] for the treatment of this disease, local injections of dexamethasone, verapamil [4].

A common drawback of therapeutic methods is the relatively low efficiency and complications, in particular, with topical use of steroids.

A known method is when a duplicate of the tunica is created by intussusception without opening cavernous bodies [5]. Separate 3-0 plication sutures in the form of an ellipse are applied to the protein membrane along the contralateral surface of the cavernous bodies to correct deformation. The location and number of sutures are controlled from time to time by creating an artificial erection.

A significant drawback of this operation is the shortening of the penis. Another complication associated with plication when using non-absorbable sutures is granulomas, which are formed at the ends of the sutures left after their cutting, as a result of which they are palpated under the skin.

Complications of this operation are damage to the urethra, loss of sensation of the head and body of the penis, hematoma, urinary retention, and constant shortening of the penis.

Closest to the proposed method is a method in which, after excision of a fibrous plaque, the defect of the protein membrane is covered with a section of the large saphenous vein [6]. As a result, 41 people (80%) had a good cosmetic result, 4 of them retained a curvature of the penis of not more than 10 °. Shortening of the penis was observed in 10 patients. In 4 patients after surgery, erectile dysfunction was noted.

As follows from the above, this method does not have a sufficiently high efficiency and is accompanied by complications in the form of shortening of the penis and erectile dysfunction.

The objective of the invention is a more effective method for the correction of erectile deformity in Peyronie's disease, eliminating erectile deformation and dysfunction.

The problem is solved by the method consisting in the fact that the penile skeleton is performed by circulatory access, a portion of the fibrous membrane of the white membrane is excised, it is excised within healthy tissues, an area of the upper third of the saphenous vein is sufficient to rotate and cover the defect of the albumen, the vein is cut off distally and retires, then is carried out under the skin of the penis, the defect of the protein membrane is closed with a section of the vein located intima inward, the edges of the flap and the white membrane are stitched dissolved.

The operation routinely ends with circumcision, or the foreskin is preserved at the request of the patient.

The flap is vascularized (due to vasa vasorum), and due to this, normal blood supply is maintained in the zone of shelter of the defect of the protein coat. This allows you to avoid sclerosis or flap rejection in the long-term postoperative period and, as a consequence, to avoid the development of repeated penile curvature and erectile dysfunction.

Clinical example. Patient B., 48 years old, was admitted to the clinic in May 1999 with a diagnosis of Peyronie's disease. From the anamnesis it is known that suffers from erectile deformity for 10 years. Previously not treated. During a physical examination, a tightly elastic, painless plaque 1 × 1.5 cm in size is palpated on the outer surface of the right cavernous body. The angle of curvature during an erection is 60 °. The length of the penis during an erection of 13 cm. In order to eliminate erectile deformation and preserve the length of the penis, the patient underwent plastic surgery of the penile membrane: penile skeletonisation was carried out by the penis, a portion of the fibrous membrane was isolated, excised within healthy tissues, an area of the upper a third of the large saphenous vein, sufficient for its rotation and covering the defect of the protein coat, the vein was cut distally and rotated, then it was held under the skin of the penis, the defect was internal cladding portion closed vein that resides intima inside edge of the flap and the tunica albuginea stitched Polyester thread 4-0. At the end of the operation, the foreskin was circumcised. In the long-term postoperative period (8 months), the patient maintained normal erectile function and penile length, and a good cosmetic result (absence of erectile deformity) was observed.

The inventive method was operated on 11 patients with Peyronie's disease. As a result of surgical treatment, a good cosmetic effect and the absence of erectile deformity were obtained during 8-12 months of observation in all patients.

LIST OF REFERENCES

1. Korneev I.A. The use of tamoxifen in Peyronie's disease. Actual problems of internal medicine and dentistry. Sat scientific labor. St. Petersburg, 1997, part 1, p. 64-65.

2. Akkus E., Carrier S., Rehman J. et al. Is colchicine effective in Peyronie’s disease? A pilot study. Urology, 1994, 44, 291-295.

3. Goncharov Yu.V., Sergeeva GP, Tutkushev S.S. Cases of surgical treatment of Peyronie's disease. Actual issues of urology. Sat scientific works / Kuibyshev. honey. Institute, Orenb. state honey. institute; under the editorship of M.N. Zilberman, 1986, p. 8-11.

4. Grinev A.V., Serdyutsky V.E., Gvasalia B.R., Dulchenko S.V. The use of verapamil in the treatment of Peyronie's disease. Andrology and Genital Surgery, 2000, No. 1, p. 81-82.

5. Ryazantsev N. I., Bogatko V. A., Nikolenko S. N., Karamyslichenko S. L. Experience in the treatment of Peyronie's disease. Modern problems of urology: Materials scientific. tr VI International Congr. urologists. Kharkov, 1998, pp. 412-413 (prototype).

Claims (1)

A method for surgical correction of erectile deformity in Peyronie’s disease, including skeletonization of the penis, isolation of the fibrosis portion of the tunic, excision of it within healthy tissue and closure of the defect with a graft, characterized in that a vascularized section of the superior third of the saphenous vein is used as a graft. penis intimate skin inside.