16 DOT ‘Nesbitt’ Plication

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