0022-5347/99/1626-2006/0

THE JOURNAL OF UROLOGY

Copyright 1999 by AMERICAN UROLOGICAL ASSOCIATION, INC.

Vol. 162, 2006 2009, December 1999

Printed in U.S.A.

MODIFIED CORPOROPLASTY FOR PENILE CURVATURE: LONG-TERM

RESULTS AND PATIENT SATISFACTION
JAMES A. DAITCH, KENNETH W. ANGERMEIER

AND

DROGO K. MONTAGUE

From the Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio

ABSTRACT

Purpose: In 1994 we began performing the modified corporoplasty technique in patients

undergoing surgery to correct penile curvature. The procedure consists of transverse closure of
the longitudinal tunical incisions. This technique allows minimal mobilization of the neurovascular bundles or corpus spongiosum and potentially decreases the risk of injury to underlying
erectile tissue. We report long-term results of and patient satisfaction with this procedure.
Materials and Methods: From June 1994 to June 1997, 28 consecutive patients 16 to 65 years
old (mean age 45) selected for corporoplasty underwent a total of 29 operative procedures for
disabling penile curvature. The etiology of curvature was Peyronies disease in 19 patients (68%)
and congenital curvature in 9 (32%). Results were obtained by retrospective chart review and
telephone interview. Long-term followup available for 19 patients ranged from 11 to 46 months
(mean 24.1).
Results: Penile straightening was excellent in 25 patients (89%) and good with less than 20
degrees of residual curvature in 2 (7%). In 1 patient in whom the procedure failed excellent
straightening was achieved after a repeat procedure. A total of 27 patients (96%) reported no
change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence.
We contacted 19 patients at long-term followup, of whom 17 and 2 reported excellent and good
penile straightening results, respectively. In 18 cases there was no change in erectile rigidity,
while in 1 there was early detumescence. Some element of erectile shortening without functional
problems was noticed by 11 patients, of whom 1 was bothered by shortening but achieves
successful intercourse. Eight patients denied shortening. In regard to the overall result 9 patients
were very satisfied, 6 satisfied, 2 neutral and 2 unsatisfied.
Conclusions: In select patients modified corporoplasty as described is an effective and durable
procedure with a high rate of patient satisfaction. Patients should be counseled preoperatively
concerning postoperative erectile shortening.
KEY WORDS: penis, penile induration, patient satisfaction

Increased public awareness of erectile function as well as

improved success rates in treating erectile abnormalities has
led to an increase in the diagnosis of penile curvature. Penile
curvature is divided into congenital and acquired types. Congenital and acquired penile curvature (Peyronies disease)
affect approximately 37/100,000 and 388.6/100,000 men,
respectively.1, 2
Initially described in 1743, Peyronies disease involves progressive fibrous scarring of the tunica albuginea of the corpora cavernosa.3 This scar restricts the elasticity of the involved tunical segment and may lead to curvature of the erect
penis. Correcting penile curvature is reserved for patients in
whom the penile deformity significantly interferes with intromission. Although to our knowledge there is no established medical therapy to manage penile curvature, numerous surgical techniques have been described. We report longterm results and patient satisfaction rates using the modified
corporoplasty technique described by Yachia for penile curvature.4
MATERIALS AND METHODS

Between June 1994 and June 1997, 28 consecutive patients

who selected corporoplasty for disabling penile curvature
underwent 29 modified corporoplasty procedures. Of the patients 9 (32%) had congenital penile curvature and 19 (68%)
had Peyronies disease. Mean age at treatment was 22.1

years (range 16 to 27) in the congenital curvature group and

56.6 (39 to 65) in the Peyronies disease group. Congenital
curvature was lateral in 3 cases, ventral in 3 and ventrolateral in 3. Of the cases of Peyronies disease curvature was
lateral in 4, ventral in 2, dorsal in 10 and dorsolateral in 3.
Curvature ranged from 40 to 90 degrees (mean 48.9) in the
congenital and 45 to 100 degrees (mean 74.7) in the Peyronies disease groups.
All patients underwent a comprehensive history and physical examination, and reported no change in erectile curvature for at least 6 months. Patients who maintained erection
but had curvature severe enough to preclude or interfere
significantly with sexual intercourse were considered candidates for the procedure. The angle and degree of penile curvature were determined by the history and by photographs of
the erect penis supplied by the patients. All patients underwent objective assessment of erectile function with RigiScan*
nocturnal penile tumescence studies and duplex ultrasonography with intracorporeal prostaglandin E1 injection. Men
with Peyronies disease were offered modified corporoplasty
or plaque excision and/or incision with dermal graft inlay.
Those with congenital penile curvature were advised to undergo modified corporplasty.
We performed the procedure as described by Yachia4 with
minor modifications. A circumcising incision was made and
the penis was degloved to its base. Artificial erection was
created using injectable saline without a tourniquet (fig. 1,

Accepted for publication July 30, 1999.

* Dacomed, Minneapolis, Minnesota.

2006

MODIFIED CORPOROPLASTY FOR PENILE CURVATURE

2007

FIG. 1. A, penis is degloved and artificial erection demonstrates lateral curvature. B, Allis clamps placed at site of maximal convexity
simulate corporoplasty.

A). The point of maximal curvature was marked with a pen.

Bucks fascia was opened longitudinally to expose the tunica
albuginea at the point of maximal curvature. To correct ventral curvature incisions were made in Bucks fascia laterally
on each side of the penile shaft and the neurovascular bundles were minimally elevated toward the midline. Allis
clamps were then applied to the tunica albuginea to simulate
corporoplasty. For dorsal or ventral curvature Allis clamps
were placed symmetrically on either side of the midline.
Artificial erection was then repeated and the Allis clamps
were adjusted as needed to straighten the penis (fig. 1, B).
The Allis clamps were sequentially removed and longitudinal
incisions were made in the tunica albuginea between the
indentations left by the jaws of the clamps (fig. 2, A). Incisions were limited to 1 cm. at any site to avoid excessive
penile indentation. Single hooks were then inserted into the
incisions and held laterally to facilitate transverse closure of
the longitudinal incisions (fig. 2, B). Closure was done using
a running, locked 3-zero polydioxanone suture on a tapered
needle. Interrupted 5-zero polydioxanone sutures were
placed to reapproximate Bucks fascia. Followup ranged from
11 to 46 months (mean 24.1) and consisted of a chart review
when the most recent office visit had been within 6 months or
telephone interview addressing recurrent curvature, erectile
rigidity and maintenance, and penile shortening. Patients
categorized overall satisfaction as very satisfied, satisfied,
neutral or not satisfied.
RESULTS

Penile straightening was excellent in 25 patients (89%)

and good with less than 20 degrees of residual curvature in 2
(7%). In 1 case rigid erection in the early postoperative period

resulted in rupture of the corporoplasty closure but straightening was excellent after a repeat procedure. A total of 27
patients (96%) reported no change in erectile rigidity or
maintenance postoperatively, while 1 with excellent straightening described early detumescence postoperatively. Except
for the initial operative failure there were no perioperative
complications or alterations in glans sensation.
The table shows long-term followup results. At a mean
long-term followup of 24.1 months we contacted 5 and 14
patients with congenital curvature and Peyronies disease,
respectively. Of the men with congenital curvature penile
straightening was excellent in 4 (80%) and good with less
than 20 degrees of residual curvature in 1. All 5 patients
reported no change in erectile rigidity, 3 noticed penile shortening of a quarter to approximately 112 inches, and 3 were
very satisfied with the procedural result, 1 was satisfied and
1 was neutral. Of the the 14 men contacted with Peyronies
disease 13 (93%) reported excellent penile straightening and
1 had less than 20 degrees of residual curvature. There was
no postoperative change in erectile rigidity in 13 patients
(93%), while 1 had difficulty maintaining erection postoperatively. Eight patients (57%) noticed penile shortening
(range 12 to 3 inches) and 6 reported no length change whatsoever. Six patients were very satisfied with the procedural
outcome, 5 satisfied, 1 neutral and 2 not satisfied. Of the
latter 2 men 1 had difficulty maintaining erection and 1 was
dissatisfied due to reported penile shortening of approximately 212 inches. Of all 19 patients 17 (89%) had excellent
penile straightening, 18 (95%) reported no change in erectile
rigidity and 15 (79%) were very satisfied or satisfied with the
procedural result.

FIG. 2. A, marked site of longitudinal incision to be made between indentations of Allis clamp. B, hooks reorient corporotomy for
transverse closure.

2008

MODIFIED CORPOROPLASTY FOR PENILE CURVATURE

Long-term followup of 19 patients with congenital curvature and

Peyronies disease

Overall
Excellent penile straightening
Preservation of erectile function
Penile shortening
Procedural satisfaction

No. Congenital
Curvature (%)

No. Peyronies
Disease (%)

5
4 (80)
5 (100)
3 (60)
4 (80)

14
13 (93)
13 (93)
8 (57)
11 (79)

DISCUSSION

The basic surgical strategy for treating men with disabling

penile curvature and adequate erectile function entails
lengthening the concave side of the curvature (plaque incision and/or excision with inlay grafting) or shortening the
convex side of the curvature (tunical plication or corporoplasty). While these 2 general approaches endure, surgical
techniques that facilitate treatment have evolved over the
last 30 years. Devine and Horton initially popularized complete plaque excision with a dermal graft inlay in men with
Peyronies disease.5 Since then, others have reported good
results using this technique or modifications with various
materials used as a patch graft.6 8 However, a shortcoming
of this approach is the extensive dissection, which has resulted in prolonged postoperative recovery time and subsequent erectile dysfunction in 12 to 30% of patients.9 12 Recently Licht and Lewis compared plaque excision with
synthetic patch grafting in 28 cases to the traditional Nesbit
procedure in 28 and modified corporoplasty in 30.13 At a
mean followup of 22 months in the plaque excision group
curvature was eliminated in 61% of cases, postoperative erectile dysfunction had developed in 18% and overall procedural
satisfaction was only 30%. An approach to alleviate these
problems is plaque incision rather than complete excision
and patch grafting of the tunical defect, as popularized by
Gelbard.14 Ganabathi et al reported excellent results with
this technique, although it still requires tedious dissection
and prolonged convalescence.15
The alternative approach of shortening the convex side of
penile curvature was initially popularized in 1965 by Nesbit
for treating congenital curvature.16 This technique entails
removal of ellipses of tunica albuginea from the point of
maximal convexity and primary closure of the tunical defects. Due to the ease of performing this procedure and relatively benign postoperative recovery it was extended for use
in men with Peyronies disease by Pryor and Fitzpatrick.17
Adequate results were reported initially but in the followup
report of Frank et al 23% of the patients ultimately had an
unsatisfactory result.18 In a more recent followup study of
these data Ralph et al noted that with proper patient selection a success rate of up to 90% was achieved with the Nesbit
operation for Peyronies disease.19 However, Sulaiman and
Gingell still reported secondary erectile dysfunction in as
many as 23% of patients who underwent the Nesbit procedure to correct penile curvature.20 This finding may be due to
scarring of the erectile bodies damaged during removal of the
tunica albuginea ellipses. To help preserve erectile function
some eliminated corporeal dissection and simply plicated the
tunica albuginea with nonabsorbable sutures at the point of
maximal curvature. While improvement in postoperative
erectile function was achieved, penile straightening was not
as durable because repair relied on the sutures only, rather
than on the natural healing process of the body.2123 In
addition, some patients complained of discomfort from granulomas caused by the nonabsorbable suture.
As early as 1973, Saalfeld24 and Lemberger25 et al described
a technique based on the Heineke-Mikulicz principle, in which
longitudinal tunical incisions at the point of maximal convexity
are closed horizontally. This technique was straightforward,
permitted the use of absorbable suture and required no dissec-

tion of the underlying erectile tissue. Yachia further refined the

technique and reported satisfactory postoperative results in all
10 patients studied, of whom 9 had congenital curvature. No
long-term data were reported.4 We adopted this procedure 4
years later and present our results with this technique.
The rates of excellent penile straightening (89%) and preservation of erectile function (95%) in our patients are in
accordance with those of other published series. Sassine et al
evaluated 32 and 23 men with congenital curvature and
Peyronies disease, respectively, who were treated with this
technique.26 At a minimum followup of 1 year 52 patients
(95%) reported satisfactory straightening and recovery of
normal sexual activity. No patient had glans hypoesthesia
and there were no reported perioperative complications. Patient satisfaction rates were not reported. Licht and Lewis
noted that curvature was eliminated in 93% of 30 patients
who undersent modified corporoplasty, none was impotent
postoperatively and 83% were satisfied with the procedure at
a mean followup of 12 months.13 Although the length of
followup was somewhat limited, no patient who underwent
corporoplasty required surgery subsequently. Our series further supports the durability of the procedure. Unlike Licht
and Lewis, who used permanent polypropylene suture material, we used absorbable polydiaxonone sutures, and observed no long-term recurrences and only 1 perioperative
failure. The use of absorbable sutures minimizes the risk of
postoperative suture palpation or suture granuloma formation. Penile shortening remains the major drawback of the
modified corporoplasty procedure, affecting 67% of the patients of Licht and Lewis and 57% of our patients. However,
properly selected and counseled patients tolerate this well. In
our series 78% of the patients were satisfied or very satisfied
at a mean of 24.1 months after the procedure.
CONCLUSIONS

As described, modified corporoplasty is an effective and

durable procedure in well selected patients with congenital
curvature of the penis or Peyronies disease. Due to the
minimal dissection necessary to perform the procedure and
the use of absorbable sutures to limit suture granuloma
formation postoperative complications are low. The procedure requires a brief operative time, may be performed on an
outpatient basis and is well tolerated with little effect on
erectile function. Excellent penile straightening and durable
outcomes result in high patient satisfaction rates. However,
patients must be counseled preoperatively concerning expected penile shortening after the procedure.
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