In daily life, men generally ignore or even neglect the “curvature of the penis”, a common symptom and sign of men, and some penile curvature is neglected because it is extremely mild. But in our patients, through communication with patients, we know that many men are distressed by this is not easy. In fact, most of them belong to the physiological curvature. Among them, congenital penile curvature deformity is often accompanied by hypospadias, but some can also occur in the urethral orthodontic opening, called simple penile curvature deformity, accounting for about 4-10% of cases of curvature deformity. The penis can be bent ventrally (inferior curvature), dorsally (superior curvature) and laterally, of which the most common cases are inferior curvature. The earlier view that penile curvature is mainly due to abnormal urethral development has been widely questioned. In recent years, more physicians have recognized that asymmetry of the corpus cavernosum is also an important cause of penile curvature. I. Diagnosis Penile curvature can be diagnosed by visual examination, but the degree of curvature and the cause often need to be clear during surgery. Before surgery, the penis should be observed during erection, and the urethra should be checked for dysplasia and the relationship between the skin of the ventral penis and the urethra by using a urethral tube or urethral probe. Before the consultation, patients can take their own photos of the erect penis, usually from the dorsal, ventral and two lateral sides to understand the direction of penile curvature. In order to effectively treat penile curvature, treatment should be selected through staging. 1.1 At present, simple penile curvature is divided into four types according to the cause of curvature: 1, skin curvature. The penis can be separated from the sleeve after the artificial erection, the penis has been straightened, then the skin bending. This type of bending degree is the lightest, correction effect is satisfactory. For example, the foreskin tie is too short, pulling the glans causing the penis to bend down. 2, fascial bending. If the artificial erection after the condom is still bent, there is a dense fibrous tissue around the urethra, the penis straightened after excision, is fascial, Buck fascia and meatus membrane development abnormalities, fiber contracture caused. Treatment of this type requires full excision of the fibrous tissue around the urethra. 3. Asymmetric curvature of the corpus cavernosum. The urethral corpus cavernosum and urethra are normal in length, but the length of the corpus cavernosum is asymmetrical on the dorso-ventral side or both sides resulting in bending. For example: a) Abnormal development of the white membrane of the penis, due to uneven development of the white membrane of the penis, one side is too tight, one side is too loose, resulting in ventral curvature, dorsal curvature and lateral curvature of the penis. b) Sclerosis of the penile corpus cavernosum, the disease not only causes dorsal or lateral curvature of the penis, but also causes erectile pain and sexual dysfunction. c) Penile trauma, excessive force during sex, incorrect sexual position, resulting in penile injury and rupture of the white membrane. The formation of scars in the future, resulting in penile curvature bad habits, such as uneven force during masturbation, wearing tight underwear so that the penis is long-term to one side of the skew. 4, urethral curvature. Abnormal development of the ventral urethral spongiosome or lack of urethral spongiosome, manifested as a short urethra, a fibrous urethra, or a thin mucosal urethra, resulting in penile curvature. This type of curvature should be treated as hypospadias, and the dysplastic urethra should be removed and reconstructed, or if the urethral structure is good, the shortage of partial urethra can be reconstructed after cutting. Among the four types, less than 10% of cases of simple penile curvature are caused by urethral dysplasia, but such curvature is more common in patients with hypospadias. The proportion of the first three types is similar. 1.2 Classification according to the severity of bending, measuring the angle of penis bending in the erect state: 1, light: bending less than 30 degrees; 2, medium: bending between 30-45 degrees; 3, heavy: bending greater than 45 degrees. Most physicians believe that curvature greater than 30 degrees requires active surgery to correct. Second, the treatment of most penile curvature will not be improved with the patient’s physical development, and on the contrary, with puberty due to the influence of sex hormones and the emergence of sexual activity and other reasons, but the symptoms are obvious, such as painful erection, can not complete sexual life. Currently, the most used surgical treatment for penile curvature is the 16-point penile white membrane folding technique and the patch transplantation technique. Simply put, the penile white membrane folding technology is to take various methods to shorten the white membrane of the penile corpus cavernosum on the opposite side of the bend, so as to correct the bend, suitable for patients with longer penis; the patch transplantation technology is to cut open the white membrane of the penis on the shortened side and use different materials to repair the defect, suitable for patients with shorter penis. 1.Surgical indications: a.bending more than 30 degrees; b.with obvious symptoms, such as painful erection and inability to complete sexual life; c.patient’s spiritual and psychological requirements. 2, surgical procedures: intraoperatively, an artificial erection test should be performed after the cuff-like release of the penis, which is an important step for further assessment of the clinical type. According to the situation, sometimes it is necessary to have several artificial erections to accurately determine the type of penile curvature and to handle it accordingly. If the penile skin is cuffed to the proximal side of the penile scrotal junction area, the erection test shows that the bend has been corrected and should be considered a cutaneous bend. If there is still a mild residual bend, the fibrous tissue around the urethra should be completely excised and loosened to see if it belongs to the second type. If there is still a persistent curvature deformity with artificial erection again and it is not related to urethral length or dysplasia, it should be treated as disproportionate development of penile corpus cavernosum and white membrane. Corrective surgery for penile curvature may be performed on the dorsal or ventral side of the penis, and the site of correction and the method used should be determined according to the development of the penis and the severity of the curvature. For severe curvature, especially those who are considered to have short urethra, it is often necessary to reconstruct the urethra at the same time to obtain success. 3, common surgical procedures: 3.1 Nesbit surgery is more widely used. It is used in cases of cavernous asymmetry (dorsal side is longer than ventral side). In the early stage, only the dorsal folded suture of the apex of the bend was made without incision or excision of the leukocutaneous tissue, but because of the short-term recurrence of the case, the modified procedure requires a transverse longitudinal suture or a wedge-shaped excision and suture of the leukocutaneous at the apex of the bend. 3.2 TAP leukotomy fold is widely used, mainly in infants and adolescents with asymmetric cavernous bodies. After it is clear that the curvature is caused by cavernous asymmetry, Buck’s fascia is separated and lifted next to the dorsal midline at the apex of the curvature (points 2 and 10) to avoid manipulation of the neurovascular bundle, and two parallel transverse incisions (approximately 8 mm long and 4-6 mm apart) are made on each side of the leukoplast, and the anterior and posterior edges of the four incision margins are sutured together (the leukoplast is embedded and knotted). 3.3 16-point penile white membrane folding method The 16-point penile correction method, created by the famous American scholar Professor Tom Lue, is commonly known as the “dorsalization” procedure in our hospital. There are three main reasons for the application of this procedure: (1) recent anatomical studies on the penis found that the nerves are distributed in a net-like pattern on the surface of the white membrane between points 1 and 5, and between points 7 and 11, and the nerve-free zone is at point 12, that is, at the dorsal midline. Parallel longitudinal sutures are made on both sides of the deep dorsal penile vein in the dorsal 12-point area of the corpus cavernosum, and multi-point sutures can be made to fold the penis if the curved section is long or thicker after development. This procedure can correct most non-skin-fascial penile curvature. 3.4 Rotation of the corpus spongiosum Commonly used in cases of heavy curvature with hypospadias. After freeing the urethral plate, the white membrane of the corpus cavernosum is incised longitudinally in the ventral midline and sutured on both sides of the corpus cavernosum under the dorsal Buck’s fascia (under the neurovascular bundle), and the corpus cavernosum is rotated dorsally to correct the hypospadias. 3.5 Splitting of the penile corpus cavernosum and urethral corpus cavernosum Also known as anterior urethral release urethral lift. In the treatment of supraurethral cleft, the penile splitting method has been applied more often in recent years, and some physicians have also applied this method to heavy cases of hypospadias with hypospadias. It has been reported that after complete splitting of the penile corpus cavernosum under delicate operation, the corpus cavernosum was fully straightened in about 2/3 of the cases and the other 1/3 curvature was significantly reduced (only another simple operation for direct correction of curvature was required). This procedure has a large surgical scope, and it is easy to damage the neurovascular of the penis, which is more demanding for the operator and more difficult to promote. 3.6 cavernous patch The white membrane folding operation is accompanied by a certain degree of penile shortening, so for heavy curvature and short penile cases, more physicians believe that the cavernous patch should be made to retain sufficient penile length. This procedure is mainly used in cases of heavy penile curvature (often with hypospadias). The commonly used transplantation sheets include white membrane sheet (taking the convex side of the white membrane and transplanting it on the concave side), dermis sheet, sphincter sheet, vein sheet, dura sheet, synthetic material sheet, etc. In recent years, due to the development of tissue engineering technology, commercial white membrane patches have entered the Chinese market and have achieved more satisfactory results. 3.7 Other surgical procedures Third, surgical complications Mainly residual bending, heavy bending after surgery residual bending incidence is relatively high. Residual bending often occurs because of the operator’s inaccurate judgment of the cause and degree of bending, according to the aforementioned surgical procedures carefully examine the cause of bending, the corresponding surgical correction, and timely application of artificial erection test to understand the correction of bending, can often avoid the occurrence of such cases. If significant residual bending occurs and there is significant dysfunction, the procedure may be repeated in a manner similar to that of the initial treatment. Urethral skin fistulas may also occur after penile curvature surgery and are associated with concurrent urethral reconstruction. Sometimes, the surgeon does not recognize that the bend is caused by urethral dysplasia and does not perform urethral reconstruction, which is also an important cause of urinary fistula after penile bend correction. The management of this type of condition is similar to the management of urinary fistula after hypospadias. Most cases of penile curvature function well after surgery, while a few may develop erectile dysfunction. It is generally believed that postoperative erectile dysfunction may be related to nerve injury, intracavernosal thrombosis, etc., and in some cases to psychological factors.