Re: New surgical technique for ventral penile curvature without circumcision

Sir, 

While the dual concept of operating via an infrapubic incision and using a “double breasted” tunical repair technique for ventral penile curvature is interesting, Alei et al. make a number of statements which must be challenged [1].

1. We would concur that discussion and documentation of penile length is vital prior to surgery for penile curvature, particularly to reduce medicolegal risk. The demonstration and advice described is vital, particularly before Peyronie’s disease surgery where the plaque itself is the shortening agent and the patient directly compares his pre- and post-operative appearance. However, in our experience, men seeking congenital curvature correction rarely have an issue with post-operative shortening complaints – indeed a ventrally curved penis when straightened may actually look longer from the patient’s viewpoint.
2. To suggest that this technique causes less shortening than other techniques is counterintuitive, and without evidence. To achieve complete penile straightening by any technique, the ventral, dorsal and lateral measurements must be equal. Therefore, how can one technique cause less shortening?
3. Stating that the described technique is “far superior” to other published papers cannot in any way be justified as this is a single-centre series with no controls.
4. Lastly the description of a “tiny surgical breach” seems to refer to a 5cm infrapubic incision – not so tiny. In any case, such incisions when used with “penile enhancement” surgery are frequently complicated by oedema and keloid scarring [2], so it should not be automatically assumed that this incision will be of minimal morbidity.

Whilst applauding the desire to minimise morbidity we would suggest further comparative studies to fully evaluate the new technique, and possibly less hyperbole in describing a case series.

Paul Sturch and Gordon Muir
Urology Department, King’s College Hospital, London, UK
e-mail: [email protected], [email protected]

References

1. Alei G, Letizia P, Alei L, Massoni F, Ricci S. New surgical technique for ventral penile curvature without circumcision. BJU Int 2014; 113: 968-74
2. Wessells H, Lue TF, McAninch JW. Complications of penile lengthening and augmentation seen at 1 referral center. J Urol 1996; 155: 1617-20