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Abstract

Volume 16, Issue 3 (May 2014) 16, 442–445; 10.4103/1008-682X.123667

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

Fatih Akbulut1, Tolga Akman2, Emre Salabas2, Murat Dinçer2, Mazhar Ortac2, Ates Kadioglu2

1Department of Urology, Haseki Training and Research Hospital, Istanbul 34096,
2Department of Urology, Istanbul Faculty of Medicine, Istanbul 34093, Turkey.

Correspondence: Dr. A Kadioglu (kadiogluates@ttmail.com)

Received: 02 April 2013; Revised: 24 May 2013; Accepted: 01 September 2013

Abstract

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures(CPC).The bundle was mobilised using the medial and lateral dissection technique in 21 (Group 1)and 13 (Group 2) patients, respectively. In the medial technique, Buck’s fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature, and a diamond-shaped tunica albuginea is excised from the midline of the penis. In the lateral technique, the bundle is mobilised using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o’clock positions via a bilateral approach. The localisation and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients’ photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P=0.01). In Group 1, 9 patients (42.8%) required 1 diamond excision, 10 (47.6%) required 2 diamond excisions, and 2 (9.5%) required more than 2 excisions; in Group 2, 6 patients (46.2%) required 2 diamond excisions and 7 patients (53.8%) required more than 2 diamond excisions (P=0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

Keywords: congenital penile curvature; lateral dissection; medial dissection; nesbit; neurovascular bundle; ventral curvature

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