Chordee repair utilizing a novel technique ensuring neurovascular bundle preservation

Area of Science:

• Urology
• Pediatric Surgery
• Surgical Technique

Background:

• Penile chordee, a condition causing penile curvature, can be surgically corrected using the Nesbit technique.
• A significant risk of the Nesbit technique is potential injury to the dorsal neurovascular bundle, leading to erectile and sensory dysfunction.
• Existing methods for penile chordee correction require careful consideration to avoid neurovascular bundle damage.

Purpose of the Study:

• To present a modified Nesbit technique for penile chordee repair that minimizes the risk of neurovascular bundle injury.
• To describe a novel method utilizing a Freer elevator for safe isolation of the dorsal neurovascular bundle prior to tunical plication.
• To evaluate the safety and efficacy of this modified technique in pediatric patients with penile chordee.

Main Methods:

• A modified Nesbit procedure involving degloving of the penis and incisions lateral to the dorsal neurovascular bundle.
• Isolation of the neurovascular bundle using a Freer elevator to separate it from the tunica albuginea.
• Dorsal plication of the ventral tunica albuginea followed by closure of Buck's fascia.

Main Results:

• Thirty-seven boys with penile chordee underwent repair using the modified technique between 1994 and the study period.
• The mean follow-up was 21 months (range 5-51 months) with no reported complications or need for reoperation.
• The technique involves elevating the neurovascular bundle before plication, ensuring its protection during the procedure.

Conclusions:

• The modified Nesbit technique effectively corrects penile chordee while safeguarding the dorsal neurovascular bundle.
• This approach offers a safe and complication-free alternative for penile chordee repair in pediatric patients.
• The described method adds minimal operative time and should be considered for chordee correction procedures involving plication.