ASM  Vol.3 No.1 , January 2013
The “Kiel Knots” Technique for Treatment of Congenital and Acquired Penile Deviation

Objectives: We propose a surgical correction of the penile curvature applying a technique based on the 16-dot plication technique modified by burying the knots in a shallow trough of incised tunica. We entitle this modification the “Kiel Knots”. Material and methods: 20 patients with a penile deviation, average age 36.8 years (24 - 52) were operated. Follow-up time was 26 months. In 8 patients the deviation was congenital, in 12 patients it was an acquired deviation. The deviation was >30? in all patients. Surgical technique: A circumcising incision was made and the penis was degloved. Buck’s fascia was incised exposing the tunica albuginea opposite the curvature. 8 dots were marked bilaterally on the tunica albugineaand a5 mmincision along the marks was made without cutting into the Corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification uses one suture for two dots with the knot buried in a shallow trough created by a scalpel. Results: The average operation time was 64 minutes. We observed a loss of penile length in 30% of the patients (0.5 - 1 cm). There were no problems with erectile function. In a follow-up of 2 years, 90% of the patients remained without recurrence of deviation. None of patients reported problems with the suture knots. Conclusion: Our technique achieves penile straightening with minimal loss of length and no erectile dysfunction.

Cite this paper: D. Osmonov and K. Jünemann, "The “Kiel Knots” Technique for Treatment of Congenital and Acquired Penile Deviation," Advances in Sexual Medicine, Vol. 3 No. 1, 2013, pp. 19-23. doi: 10.4236/asm.2013.31004.

[1]   R. Tal, O. Nabulsi, C. J. Nelson and J. P. Mulhall, “The Psychosocial Impact of Penile Reconstructive Surgery for Congenital Penile Deviation,” The Journal of Sexual Medicine, Vol. 7, No. 1, 2010, pp. 121-128. doi:10.1111/j.1743-6109.2009.01574.x

[2]   J. F. Smith, T. J. Walsh, S. L. Conti, P. Turek and T. Lue, “Risk Factors for Emotional and Relationship Problems in Peyronie’s Disease,” The Journal of Sexual Medicine, Vol. 5, No. 9, 2008, pp. 2179-2184. doi:10.1111/j.1743-6109.2008.00949.x

[3]   O. Shaeer and K. Shaeer, “The Global Online Sexuality Survey (GOSS): Erectile Dysfunction among Arabic-Speaking Internet Users in the Middle East,” The Journal of Sexual Medicine, Vol. 8, No. 8, 2011, pp. 2152-2160. doi:10.1111/j.1743-6109.2011.02297.x

[4]   Francois Gigot de la Peyronie, “Sur Quelques Obstacles, qui S’Opposent à L’Ejaculation Naturelle de la Semence,” Mémoires de l’Académie Royale de Médecine, Paris, 1743, pp. 425-434.

[5]   R. E. Fricke and J. H. Varney, “Peyronie’s Disease and Its Treatment with Radium,” Journal of Urology, Vol. 59, No. 4, 1948, pp. 627-630.

[6]   V. Meineke, C. Uebler, F. M. Kohn, et al., “Radiotherapy in Benigndiseases: Morbus Peyronie,” Strahlentherapie und Onkologie, Vol. 179, No. 3, 2003, pp. 181-186.

[7]   R. Dickstein, J. Uberoi and R. Munarriz, “Severe, Disabling, and/or Chronic Penile Pain Associated with Peyronie Disease: Management with Subcutaneous Steroid Injection,” Journal of Andrology, Vol. 31, No. 5, 2010, pp. 445-449. doi:10.2164/jandrol.109.008029

[8]   R. T. Strebel, S. Suter, T. Sautter and D. Hauri, “Extra Corporeal Shock Wave Therapy for Peyronie’s Disease Does Not Correct Penile Deformity,” International Journal of Impotence Research, Vol. 16, No. 5, 2004, p. 4.

[9]   A. Müller and J. P. Mulhall, “Peyronie’s Disease Intervention Trials: Methodological Challenges and Issues,” The Journal of Sexual Medicine, Vol. 6, No. 3, 2009, pp. 848-861. doi:10.1111/j.1743-6109.2008.01081.x

[10]   L. A. Levine, “Partial Plaque Excision and Grafting (PEG) for Peyronie’s Disease,” The Journal of Sexual Medicine, Vol. 8, No. 7, 2011, pp. 1842-1845. doi:10.1111/j.1743-6109.2011.02370.x

[11]   S. V. Perovic and R. P. Djinovic, “Current Surgical Management of Severe Peyronie’s Disease,” Archivos Espa?oles de Urología, Vol. 63, No. 9, 2010, pp. 755-770.

[12]   E. Chung, E. Clendinning, L. Lessard and G. Brock, “Five-Year Follow-Up of Peyronie’s Graft Surgery: Outcomes and Patient Satisfaction,” The Journal of Sexual Medicine, Vol. 8, No. 2, 2011, pp. 594-600. doi:10.1111/j.1743-6109.2010.02102.x

[13]   O. Shaeer, “Trans-Corporal Incision of Peyronie’s Plaques,” The Journal of Sexual Medicine, Vol. 8, No. 2, 2011, pp. 589-593. doi:10.1111/j.1743-6109.2010.02078.x

[14]   M. L. Eisenberg, J. F. Smith, A. W. Shindel and T. F. Lue, “Tunica-Sparing Ossified Peyronie’s Plaque Excision,” BJU International, Vol. 107, No. 4, 2011, pp. 622-625. doi:10.1111/j.1464-410X.2010.09546.x

[15]   G. Colpi, G. Piediferro, F. Castiglioni, G. Contalbi and L. Carmignani, “Penile Septoplasty for Congenital Ventral Penile Curvature: Results in 51 Patients,” Journal of Urology, Vol. 182, No. 4, 2009, pp. 1489-1494. doi:10.1016/j.juro.2009.06.059

[16]   R. H. Nesbit, “Congenital Curvature of the Phallus: Report of Three Cases with Description of Corrective Operation,” Journal of Urology, Vol. 93, 1965, pp. 230-232.

[17]   R. J. Lemberger, M. C. Bishop and C. P. Bates, “Nesbit’s Operation for Peyronie’s Disease,” British Journal of Urology, Vol. 56, 1984, pp. 721-723. doi:10.1111/j.1464-410X.1984.tb06156.x

[18]   E. Essed and F. H. Schroder, “New Surgical Treatment for Peyronie’s Disease,” Urology, Vol. 25, No. 6, 1985, pp. 582-587. doi:10.1016/0090-4295(85)90285-7

[19]   C. van der Horst, F. J. Martinez Portillo, C. Seif, et al., “Tunica Plication with Horizontal Incisions of the Tunica Albuginea in the Treatment of Congenital Penile Deviations,” Aktuelle Urologie, Vol. 34, No. 7, 2003, pp. 478-480.

[20]   L. S. Baskin and T. F. Lue, “The Correction of Congenital Penile Curvature in Young Men,” British Journal of Urology, Vol. 81, No. 6, 1998, pp. 895-899. doi:10.1046/j.1464-410x.1998.00645.x

[21]   J. F. Smith, A. W. Shindel, Y. C. Huang, et al., “Pentoxifylline Treatment and Penile Calcifications in Men with Peyronie’s Disease,” Asian Journal of Andrology, Vol. 13, No. 2, 2011, pp. 322-325. doi:10.1038/aja.2010.117

[22]   S. S. Gholami and T. F. Lue, “Correction of Penilecurvature Using the 16-Dot Plication Technique: A Review of 132 Patients,” Journal of Urology, Vol. 167, No. 5, 2002, pp. 2066-2069. doi:10.1016/S0022-5347(05)65085-9

[23]   T. Akman, L. Gurkan, O. Sanli, K. Onem, M. Tezer and A. Kadioglu, “Clinical Characteristics of Pure Notching Group in Peyronie’s Disease,” Program and Abstracts of the Sexual Medicine Society of North America Fall Meeting, New York, 17-20 November 2005.