Halim Hattat

Incision and Venous Patch Graft in the Surgical Treatment of Penile Curvature in Peyronie’s Disease

Objectives: To assess the efficacy of incision and venous patch grafting method in the surgical treatment of the curvature in Peyronie’s disease. Methods: Fifty–eight patients with Peyronie’s disease underwent incision of the tunica albuginea with Peyronie’s plaque(s) and venous patch grafting between 1994 and 1999. Segment(s) of lower saphenous vein in 48, deep dorsal vein in 7, and upper saphenous veins were used in 3 cases as venous patch(es). Assessment of the potency status, curvature, and vascular structure were performed pre–operatively with detailed history, counselling, autophotography, and color Doppler ultrasonography. Realistic expectations from the surgery was discussed with the patients in advance. Postoperative evaluation was performed at least twice, in the 6th week and the 3rd month. The third evaluation was done in 12–36 months by telephone. Results: Fifty of the patients (86%) achieved straight erections after the surgery. Five patients (9%) had improvement in their penile curvature that enabled them to perform sexual intercourse easily. In 3 of our patient (5%) recurrence of the curvature was observed. Penile shortening of 0.5–1.5 cm was observed in 13 of the cases (22.4%). Fifty–four cases (93%) reported no change in their quality of erections. Conclusion: Incision of the tunica albuginea and venous patch grafting technique is a very satisfactory surgical method in the treatment of the curvature in Peyronie’s disease.

Superficial dorsal penile vein thrombosis (penile Mondor's disease)

In our center between 1992 and 1994 penile Mondors disease (superficial dorsal penile vein thrombosis) was diagnosed in 5 patients aged 20–39 years. In all patients the thromboses were noted 24–48 hours after a prolonged sexual act with or without an intercourse. The main symptom was a cord-like thickening of the superficial veins, which were painless or slightly painful. Doppler examination of the superficial dorsal vein revealed obstruction of the vessels. In 2 patients the retroglandular plexus was also involved. Patients were treated with anti-inflammatory medications (Tenoxicam or Ibuprofen). The resolution of the thrombosis occurred uneventfully within 4–6 weeks. No recurrence or erectile dysfunction was noted in any of the patients. Penile Mondors disease is a benign pathology of the superficial dorsal penile vein and should be taken into account in the differential diagnosis of penile pathologies.

RETROSPECTIVE ANALYSIS OF MEDICOLEGAL CASES AND EVALUATION FOR ERECTILE FUNCTION

Erectile function (EF) is an important question in lawsuits for divorce, rape, and damages. In this study, a method to evaluate medicolegal cases is defined, and the characteristics of the 265 cases screened for EF between 1989 and 1997 were analyzed. Interview, physical examination, psychometric evaluation, nocturnal penile tumescence, serum hormone levels and blood chemistry, intracavernosal drug injection, penile Doppler ultrasonography, and pharmacocavernosometry and pharmacocavernosography tests were used for diagnosis. The tests performed were selected according to the age of the subject. Of the 265 cases 128 (48.3%) were for divorce, 116 (43.7%) were for rape, and 21 (8%) were for indemnity relating to lawsuits for damages. In only 7 cases (2.7%) was the defendant <15 years of age. Organic pathology for erectile dysfunction (ED) was present in 22% of lawsuits for divorce, 40.5% of lawsuits for rape, and 33.4% of lawsuits for damages. Three men in cases of divorce and 2 men after genital trauma due to traffic accident suffered psychological ED. This study indicates that lawyers may abuse the assertion of ED in lawsuits for divorce and rape. In 128 divorce cases the defendant was accused of being impotent, but evaluation proved that 75.8% had normal EF. In lawsuits for rape, 59.5% of defendants had normal EF although the lawyers of the rapist claimed their clients were impotent. The investigation, interpretation, and characteristics of medicolegal cases may differ in countries with different cultures.