Midline dorsal plication technique for penile curvature repair

Purpose: Most penile curvature repair techniques involve excision of the tunica albuginea and mobilization of the neurovascular bundles. Recent neuroanatomical studies of the neurovascular bundles have demonstrated the distribution of nerve fibers and identified the 12 o'clock position as the only nerve-free position. We present the results of penile curvature repair with the midline dorsal penile plication technique. Materials and Methods: A total of 45 penile plication procedures were performed in 43 pediatric patients, of whom 39 had mild to moderate and 4 had severe curvature. Eight patients had previously undergone penile curvature repair. After the induction of an artificial erection test a 4 or 5-zero polypropylene plication suture was placed at the point of maximal curvature at the 12 o'clock position. Results: Of patients with mild to moderate curvature 97% underwent a successful initial procedure. Satisfactory results were achieved in only 2 of the 4 patients with severe curvature. Two of the 3 initial failures were successfully reoperated using the same technique. The procedure was successful in all 8 patients who had previously undergone operation for curvature repair. Conclusions: Midline dorsal penile plication is a safe, simple to perform procedure that achieves excellent results in patients with mild to moderate curvature. It is a useful technique in patients in who previous repairs have failed. We suggest other repair techniques for severe curvature.