Penile curvature Overview Penile curvature can be divided into congenital penile curvature and secondary penile curvature. Congenital penile curvature is very rare, its incidence is about 37/100000, usually accompanied by hypospadias, without hypospadias congenital penile curvature, called congenital simple penile curvature, or called primary penile curvature, about 4% of congenital penile curvature patients a 10%. Secondary penile curvature is caused by penile sclerosis), trauma, infection, and skin sclerosis and other diseases, which is more common caused by penile sclerosis. First, the etiology of penile curvature is still unclear, most scholars believe that in the embryonic period due to androgen deficiency or insensitivity, resulting in penile and urethral development stagnation or dysplasia. It may be related to the following factors. 1, urethral dysplasia, lack of urethral spongiosome: the urethral spongiosome is gradually fused from the left and right urogenital folds from the root to the head end of the penis formed by the genital nodes around the 10th week of embryonic life. When the urethra originating from the ectoderm at the head of the penis and the urethra originating from the primordium of the urogenital sinus should unite at the coronary sulcus, there will be no curvature. If the proximal section of the coronal sulcus is combined, the urethra formed by the ectoderm lacks the urethral corpus cavernosum and is replaced by a primitive fiber to produce pulling and thus the penis is bent. 2, abnormal development of penile fascia: urethral mucosa, urethral corpus cavernosum development is normal, but Buck’s fascia and subcutaneous meatus development is abnormal, pulling the penis caused by penile curvature. 3, abnormal development of penile white membrane: penis ventral and dorsal white membrane development is asymmetrical, dorsal white membrane is too much and ventral from the membrane is relatively short resulting in penile curvature. Secondary penile curvature, due to penile sclerosis and repeated trauma, infection resulting in local inflammation of the white membrane, fibrosis, plaque formation caused by penile curvature. The penile curvature caused by skin sclerosis, may be due to the abnormal immune response of the body and cause extensive fibrosis of the penile white membrane, resulting in penile curvature. 4, penile skin development abnormalities: penile body and skin adhesion caused by penile curvature. Second, the pathology and typing usually based on typing will not be accompanied by hypospadias penis curvature is divided into three types: Type I: urethral spongiosomal dysplasia, urethra consists only of a thin mucosal tube, directly under the skin, without the urethral spongiosome and its surrounding fascia, the penis is pulled under the urethra and the two sides of the fibrous tissue, ventral bending, the most serious lesions. Type II: congenital dysplasia of the fascia. The urethral corpus cavernosum is normally developed, but Buck’s fascia and Dartos fascia are dysplasia pulling the penis and causing ventral curvature. Type III: penile white membrane development asymmetry type, urethral corpus cavernosum and Buck’s fascia development is normal, penile curvature caused by dysplastic Dartos fascia pulling. Type I (skin contracture type): the main manifestation is simple penile curvature, no urethral defect, urethral opening is normal. Type II (fascial congenital dysplasia type), mainly manifested as: the opening of the urethral opening in the normal position of the glans penis; penile curvature; there may be midline deviation but no turban-like covering. Type III (asymmetrical development of penile corpus cavernosum), the main clinical manifestations are: the opening of the external urethral opening on the ventral surface of the glans penis is close to the normal position; the distal urethra is membranous to varying degrees and is tightly attached to the ventral surface of the penis; the penile foreskin is turban-like covering the dorsal surface of the penis; the ventral foreskin is absent. Fourth, the diagnosis of penile curvature without hypospadias can be clearly diagnosed by physical examination. But at the same time, attention should be paid to differentiate it from the penile head type and coronal sulcus type hypospadias. V. Treatment Patients with moderate or severe penile curvature, due to the difficulty of sexual intercourse can occur in adulthood, so should be implemented as soon as possible to correct the curvature. The surgery for congenital simple penile curvature should follow three basic principles: 1. excision of the fibrous strip between the urethral corpus cavernosum and the penile corpus cavernosum to loosen and lengthen the urethra; 2. appropriate shortening of the length of the dorsal penile corpus cavernosum; 3. urethral lengthening or urethroplasty. 6.Surgical method 1.Preoperative preparation: preoperative perineal skin preparation, artificial erection of the penis, observation of the degree and direction of penile curvature, preoperative conversation to inform patients and their families that the length of the penile corpus cavernosum may be shortened after surgery, and the sensitivity of the penile head may be reduced. 2.Anesthesia: choose the anesthesia method according to the patient’s age, usually using epidural anesthesia or general anesthesia. 3. Body position: supine position. Postoperative treatment: 1. Fix the penis upward after surgery; 2. Pay attention to the penis, the oozing and edema of the prepuce incision, and observe the blood flow of the penis after surgery; 3. Inhibit penile erection, either orally or intramuscularly by injecting hexestrol 4mg, 1 time/day, or chlorpromazine 12.5mg, 1 time/day, and isopropazine 25mg, 1 time/day, starting two days before surgery. 4. Remove the catheter about one week after surgery. 5.The stitches are removed 10-12 days after surgery. 6.No sexual life for 6 weeks after. VII. Complications 1. Unsatisfactory correction of penile curvature Mainly due to the factors leading to bending not completely removed. Ignore the existence of the factors of imbalance in the development of the dorsal and ventral length of the penile corpus cavernosum. After straightening the penis ventral skin is relatively too short to produce pulling and postoperative infection, scar contracture and other factors lead to unsatisfactory correction, these as long as the use of intraoperative establishment of artificial erection, white membrane folding, the excess dorsal skin transfer to cover the ventral side and other measures, generally satisfactory results can be obtained. 2, urinary leakage Mostly due to intraoperative urethral injury, especially in patients with urethral cavernous dysplasia. The anterior urethra is only a thin mucosal tube, which is easily damaged, and the urethra should be inserted first for marking. When freeing the urethra must be very careful, starting from its side carefully dissected, lifting the urethra to use wide film, do not use silk wire lifting or clamping, local bleeding points do not use electrocautery to stop bleeding million. If a tear is found in the urethra, 5-0 silk sutures can be used to mend it. If there is no damage to the urethra, a catheter can be left in place, and in patients with urethral injury, a cystostomy must be performed. 3. Urethral stricture. It may be related to the selection of large catheters and improper postoperative pressure bandaging causing local urethral mucosal necrosis and infection, such as the appropriate size of the urethra. If the size of the urethral catheter is appropriate, pay attention to the dressing not to be too tight, it can be avoided.