The dissertation is devoted to improving the outcomes of surgical treatment for congenital penile curvature by studying the pathomorphological and hemodynamic parameters of the penis, as well as the psychosexual state of patients, which influence erectile function.
The study is based on the results of the examination and treatment of 83 patients with congenital penile curvature
Preoperative evaluation of all patients included a clinical examination and laboratory tests - complete blood count and biochemical blood analysis with measurement of creatinine, electrolytes, total protein, bilirubin, glucose, and coagulation parameters; and urinalysis.
Preoperative evaluation included a detailed medical history, physical examination, and penile Doppler ultrasound.
Penile curvature was measured by photographing the penis in three positions following a drug-induced erection or by self-photography following a natural erection. The length of the erect penis was also measured during erection.
Using Doppler ultrasound and hemodynamic measurements in the deep penile artery, both in the flaccid state and in the pharmacologically induced erectile state following intracavernosal injection, hemodynamic parameters were systematically measured and recorded, specifically peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI).
Surgical treatment was performed using three techniques: the Nesbit procedure, the Nesbit plication corporoplasty modified by P.A. Shcheplyov and the tunicoplication combined with elliptical resection of the longitudinal layer of the penile tunica albuginea to correct congenital penile deviations (TwR).
Psychosexual assessment was conducted using the following questionnaires: the Sexual Quality of Life Questionnaire for Men (SQOL-M), the Beck Depression Inventory (BDI-II), and the International Index of Erectile Function (IIEF-5).
Тhe scientific novelty of the study lies in the fact that, for the first time, penile hemodynamic parameters were studied depending on the degree and direction of deviation.
For the first time, a comprehensive study of patients and the impact of the disease on psychosexual status depending on age category was conducted, and the necessity of surgical treatment specifically for young patients was substantiated to avoid prolonged psychosexual depression.
The morphological features of the tunica albuginea of the corpus cavernosum in patients with congenital penile deviations were studied.
An analysis of the advantages and disadvantages of various surgical techniques for treating penile deviations was conducted.
The practical significance of the results lies in the fact that the application of the TwR has allowed for a statistically significant minimization of the risk of specific postoperative complications, in particular the complete elimination of palpable suture knots and ligature fistulas, and demonstrates consistently high efficacy regardless of the direction of the curvature.
The use of the TwR ensures the lowest recurrence rate of curvature—10.3%—compared to 14.8% (Shcheplev) and 18.5% (Nesbit). At the same time, the procedure does not have a negative impact on patients’ erectile function.
Optimization of the surgical technique has made it possible to reduce the level of subjective discomfort from palpable sutures to 0% and to decrease the proportion of patients dissatisfied with the loss of penile length to 6.8%, which is the best indicator among the studied groups and contributes to faster psychosocial rehabilitation of patients.
The materials of the dissertation have been implemented in the practice of the andrology department of the Kharkiv Regional Medical Clinical Center of Urology and Nephrology named after V. I. Shapoval (Kharkiv), and are used in the educational process at the A.G. Podrez Department of Urology, Nephrology, and Andrology at Kharkiv National Medical University.
