Editing Peyronie's Disease (section)

====== Tunical plication (tunical shortening procedures) ======

* '''<span style="color:#ff0000">Aims to shorten the longer (or convex) side of the tunica albuginea to match the length to the shorter side</span>'''
* '''<span style="color:#ff0000">Recommended for (3):</span>'''
*# '''<span style="color:#ff0000">Simple curvature <70°</span>'''
*# '''<span style="color:#ff0000">Minimal/absent hourglass or hinge effects</span>'''
*# '''<span style="color:#ff0000">Adequate penile length;</span>''' those in whom the anticipated loss of length would be < 20% of total erect length
* '''Advantages (4):'''
*# '''Shorter surgical time'''
*# '''Good cosmetic outcomes'''
*# '''Minimal effect on rigidity'''
*# '''Simple and safe surgery'''
*# '''Effective straightening'''
* '''Disadvantages (2):'''
*# '''Penile shortening'''
*#* Predictors of shortening include direction and degree of curvature
*#** Ventral curvature >60° has greatest potential for loss of penile length
*# '''Failure to correct an hourglass or hinge'''
* '''Complications (7):'''
*# '''Persistent pain'''
*# '''Persistence or recurrence of penile curvature''' (>30º, ≈10%)
*# '''Penile hematoma''' (≈5%)
*# '''Urethral injury''' (≈1%)
*# '''Palpable suture knots'''
*# '''Loss of penile length by default, but tend to preserve potency'''
* '''<span style="color:#ff0000">Types of plication surgery (3):</span>'''
** '''<span style="color:#ff0000">Nesbit</span>''': '''excision of an elliptical segment''' of the tunica on the contralateral side of the curvature
** '''<span style="color:#ff0000">Yachia</span>''': full-thickness '''vertical incision''' is made on the vertical shaft tunica, which is '''then closed transversely''' to shorten the ventral aspect and correct the curvature
** '''<span style="color:#ff0000">16-dot</span>'''
** '''Imbrication procedures''' are used to avoid making a full-thickness tunical incision and fold the tunica to correct curvature
** '''No head-to-head studies of the primary types of plication surgery'''
* During a dorsal penile plication, the deep dorsal vein is occasionally ligated, dissected, and excised and the plication sutures are then placed in the venous bed.