Product Summary: AMA rates

Correction of penile chordee / curvature with penile block

Item Number: 37417, 18262, 105

Why is it done?

  • To treat a acquired deviation of an erect penis.
  • Usually occurs in males 55-65 years of age.
  • Can be associated with previous penile trauma, usually no associated history.
  • A dorsal curvature is more common than a ventral one.
  • Pain is usually the presenting symptom with a gradually worsening curvature.
  • The curvature may be so bad that penetration becomes impossible.
  • Associated with the Connective disorder Duputryens Contracture, which is an auto-immune disease.
  • Worse cases may require a penile prosthesis.

Pre-requirements

  • An informed consent is required from the patient/ parents.
  • Patients are informed that this may shorten the penis to the length of the shorter side of the penis, usually 2-3 cm.
  • In patients with limited length, a lengthening procedure may be indicated and will be referred to a colleague.
  • Patients may not eat or drink from 6-8 hours prior to surgery according to age.
  • Adult patients are to refrain from smoking before the procedure.
  • Patients allergic to IODINE/CHLORHEXIDINE should clearly state this at the Pre-admission clinic as well as to theatre staff and Dr Schoeman.
  • Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. Clexane injections may be substituted.
  • Patients with cardiac illnesses require a cardiologist / physician’s report.
  • A chest X-ray is required for patients with lung disease.
  • Pre-op blood tests are required 4 days prior to surgery.
  • Be prepared for an overnight stay.

How is it done?

    • This procedure is done under general anaesthetic.
    • Supine position.
    • The Foreskin is loosened proximal to the glans with a circumferential incision and the whole penile skin is retracted to the base of the penis.
    • An artificial erection will be induced by injecting a sterile saline solution into the penile corpora cavernosa with a tourniquet around the base.
    • Non-dissolvable sutures will be placed on the sides opposite to the diseased areas in an attempt to pull the erect penis into a straight alignment.
    • Occasionally a circumcision may result due to complications with this technique, yet foreskin preservation is attempted.

  • If there is a dorsal curvature , ventral sutures are laced and the penis pulled in up right position, therefore sutures are always placed on the opposite site avoiding vital structures such as.
  • A in catheter will be inserted until you are awake.
  • A dressing is then applied, which should be removed after 72 hours.
  • A local anaesthetic is injected at the base of the penis as a penile block thus giving post-operative pain relief for the next 4-6 hours.

What to expect after the procedure?

  • Any anaesthetic has its risks and the anaesthetist will explain such risks.
  • Bleeding is a common complication.
  • A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • Sutures may tear loose with vigorous use of erect penis, and the procedure may then require revision.
  • An infection of the wound may occur and requires immediate attention.
  • Necrosis of the foreskin can occur in rare circumstances.
  • DANGER SIGNS: A wound that swells immediately, fever, and puss. Contact Dr Schoeman or the hospital immediately as this occurs in up to 15–20% of all cases.

What next?

  • Dressings should be kept dry for the initial 72 hours after surgery and soaked off in a bath thereafter.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • The catheter will be removed as soon as you are awake, or if there are concerns, the following morning.
  • On discharge, a prescription may be issued for patients to collect.
  • Patients should schedule a follow-up appointment with Dr Schoeman 2 weeks after the procedure.
  • There will be signs of bruising for at least 10 days.
  • Refrain from using your erect penis for 3-4 weeks.
  • The suture-line will be hard and indurated for at least 8-10 weeks.
  • Sick leave will be granted for 10 days.
  • Please direct all further queries to Dr Schoeman’s rooms.
  • PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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16 DOT ‘Nesbitt’ Plication