Long-Term Functional Outcomes After Surgical Correction of Congenital Penile Curvature.

OBJECTIVES: To present the surgical results and the functional outcomes after surgical correction of congenital penile curvature (CPC) by different plication techniques. METHODS: All consecutive patients operated for CPC from 2010 to 2019 in a university hospital of Lyon, France, were retrospectively identified and included for analyzing surgical results. They were proposed to answer a questionnaire (between January 2020 and May 2020) that included questions of the Peyronie's Disease Questionnaire (PDQ), the Erection Hardness Score (EHS), and the Internal Index of Erectile Function (IIEF5), along with non-validated specific questionnaires. RESULTS: A total of 31 patients were included, their mean (SD) age was 21.2 (4.9) years, their mean (SD) follow-up of 55.5 (33.7) months. The principal curvature was ventral for 25 (80.6%) patients. After the surgery, 28 (90.3%) patients had straight penis or a residual curvature less than 15°, and 2 (6.5%) required a second surgery. A total of 23 (74.2%) patients answered the post-operative questionnaire. The mean (SD) scores were 1.2/16 (1.8) for PDQ-Bothered Score, 1.5/24 (2.1) for PDQ Psychological and Physical, and 1.7/30 (2.7) for PDQ pain. The mean (SD) IIEF5 was 22.7/25 (4.6). All patients had an EHS of 4/4. There were 10 patients who never had sexual intercourse before the surgery and 4 who still had not when answering the questionnaire. All patients (23/23) were either "satisfied" or "very satisfied" with the outcomes of the operation, and 13 (56.5%) reported improvement of their sexual life after surgery. CONCLUSION: This study confirmed the favorable outcomes of surgical plication for CPC with low morbidity. A concomitant sexological care may be useful for some patients.

Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment.

INTRODUCTION: Penile corporoplasty is a well-established treatment method of congenital penile deviation (CPD). Anatomical results are good with only slight differences between surgical procedures used. The disease however has huge influence on young male quality of life. This issue is not well analyzed in the literature. AIM: The aim of the study was to evaluate quality of life of the patients affected with CPD before and after the surgical treatment METHODS: Study population consisted of 107 patients with CPD referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function. RESULTS: Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method. CONCLUSION: CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being.

Tunica albuginea underlap--a new modification of the Nesbit procedure: description of the technique and preliminary results.

INTRODUCTION: We describe a new surgical technique for the treatment of penile curvature that combines features of the Nesbit procedure with features of tunical plication. U-shaped flaps of tunica albuginea are freed from the corpus cavernosum. The flaps are brought under the remaining tunica albuginea and are fixated with single absorbable sutures. As the defects of the tunica are sealed tightly and with high tensile strength by double layers of tunica albuginea, correction of the abnormal curvature is achieved. AIM: To present our experience with a new surgical technique for the treatment of penile curvature. METHODS: Between 2008 and 2011, 50 patients underwent the underlap technique because of Peyronie's disease (37) or congenital penile deviation (13) in a single center. MAIN OUTCOME MEASURES: Preoperative and postoperative evaluation included the Erection Hardness Score (EHS) and the Symptom Score for Induratio penis plastica (IPP-SSC), a symptom score for penile deviation that was based on a consensus of regional andrologists. Clinical data concerning the early postoperative outcome were analyzed retrospectively using standardized items. RESULTS: Mean age ± standard deviation was 59.7 ± 8.4 years for patients with Peyronie's disease and 34.1 ± 7.8 years for patients with congenital penile deviation. The mean follow-up period was 27 months. The major complication rate was 4%, overall satisfaction 86%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 6%. The mean difference of preoperative and postoperative IPP-SSC was 8.1 (95% confidence interval [CI] 7.24 to 8.96). The mean difference of preoperative and postoperative EHC was -0.03 (95% CI -0.16 to 0.09). CONCLUSIONS: Preliminary results obtained with the underlap technique showed promising outcome with minimal morbidity. The new technique might have three main advantages: more flexible intraoperative correctability of the curvature, tighter sealing of the tunical defects, and greater tensile strength of the plications.

The psychosocial impact of penile reconstructive surgery for congenital penile deviation.

INTRODUCTION: A variety of surgical techniques to correct congenital penile deviation (CPD) have been described. Although surgical outcomes have been reported, the impact of this treatment on sexual relationship, confidence, self-esteem, and sexual function has never been established. AIM: To assess the impact of surgical treatment for CPD on sexual relationship, confidence, self-esteem, and sexual function, employing validated instruments. MAIN OUTCOME MEASURES: The Self-Esteem and Relationship (SEAR) and International Index of Erectile Function (IIEF) questionnaires. METHODS: Prospective, longitudinal, uncontrolled study of 32 men undergoing penile reconstructive surgery for CPD. Assessment of change in sexual relationship, confidence, self-esteem, and sexual function scores. RESULTS: Twenty (37.5%) patients had ventral and 12 (62.5%) had lateral curvature, mean magnitude was 37 +/- 12 degrees . Significant improvement in SEAR domains scores was observed in sexual relationship (82 vs. 40, P < 0.01), overall relationship (86 vs. 62, P < 0.01), and confidence (88 vs. 58, P < 0.001). While mean IIEF erectile function domain score was unchanged: 24 +/- 3.6 and 25 +/- 2.5, before and after surgery, respectively (P = 0.85), significant improvements were observed in the libido (8 vs. 5, P = 0.02) and satisfaction (22 vs. 15, P < 0.01) domains of the IIEF. Predictors of improvement in SEAR and IIEF scores were perceived complete straightening and penile length preservation. CONCLUSIONS: Penile reconstructive surgery for CPD is associated with significant improvements in overall relationship, sexual relationship, confidence, libido, and satisfaction, as reflected by higher scores in three of the four domains of the SEAR questionnaire and improvements in two of the four domains of the IIEF.

Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature.

AIM: To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction (ED). METHODS: Fifty-four patients (mean age 24 years, range 20-31 years) whose congenital penile deviation due to physiological curvature was>or=25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde's parameters (contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability). All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. RESULTS: Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. CONCLUSION: The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.

Outcome analysis of severe chordee correction using tunica vaginalis as a flap in boys with proximal hypospadias.

PURPOSE: There is ongoing controversy regarding optimal treatment for severe ventral curvature. It has been suggested that ventral corporeal lengthening may be associated with recurrent curvature and erectile dysfunction. To further assess these issues we reviewed our experience with ventral penile lengthening for correcting the severe ventral curvature associated with proximal hypospadias. MATERIALS AND METHODS: We reviewed the records of 38 boys with severe hypospadias and congenital ventral curvature greater than 45 degrees who were treated at our institution from 1995 to 2004 with placement of a flap or graft in the corporeal bodies to straighten the phallus. Of the patients 21 had perineal and 17 had penoscrotal hypospadias, including 22 with associated penoscrotal transposition and/or bifid scrotum and 6 with ambiguous genitalia. Testosterone stimulation before surgery was given in 11 children at surgeon discretion. RESULTS: Median age at surgery was 15 months. The urethral plate was divided in 94.7% of patients. A tunica vaginalis flap was used alone in 23 cases and associated with dura, pericardium or small intestinal submucosa in 8, 2 and 1, respectively. The remaining 4 patients underwent ventral grafting alone, including lyophilized dura in 1, pericardium in 1 and dermis in 1. Urethral reconstruction was achieved by the transverse island flap technique or 1 of its modifications in 34 children. Four boys underwent a 2-stage procedure. Followup available on 35 of 38 patients was 1 to 11 years (median 5.3). Recurrent ventral curvature in 5 of 35 patients was mild in 1 and clinically significant, requiring re-intervention, in 4. Four of 9 patients (44.4%) who underwent corporeal grafting with lyophilized dura had recurrent ventral curvature vs 1 of 23 (4.3%) who had a tunica vaginalis flap (chi-square 5.14, p = 0.02). At last followup straight erections were documented by patients and/or parents in 30 of 35 children (85.7%). CONCLUSIONS: The short-term outcome of ventral penile lengthening using tunica vaginalis flap alone for correcting severe chordee is favorable with a 95% success rate. Dural grafts were associated with a higher risk of recurrent ventral curvature compared to tunica vaginalis flaps. Although most of our patients were not yet adults, when chordee and erectile dysfunction may become apparent, we believe that tunica vaginalis flap repair is a good option for correcting severe ventral curvature.

'Straightening-reinforcing' technique for congenital curvature and Peyronie's disease.

OBJECTIVES: We report an initial randomised study on surgical techniques with subsequent intensive application of our procedure. MATERIALS AND METHODS: We modified Ebbehoj-Metz technique by a 'straightening-reinforcing' (S-R) double stitch: the first performs the plication, the second tightens it, thus preventing tension during erection. This is different to the simple Ebbehoj-Metz stitch that only provides plication but, as it does not provide reinforcement, does not prevent recurrence. From 1995 to 2000 78 plications were performed: 60 for congenital curvatures (age range 18-32 years) and 18 for Peyronie's disease (PD; age range 36-58 years). During the first 3 years, i.e. between 1995 and 1998, patients were randomised to S-R plication (20 congenital and 5 PD) and Nesbit procedure (20 congenital and 5 PD), for a total number of 50 patients (40 congenital and 10 PD). The last 28 patients, operated between 1998 and 2000, were assigned exclusively to S-R plication. We delayed study publication in favour of an adequate follow-up. RESULTS: No patient reported a decrease in erectile function and all reported easy vaginal penetration within 3 months. In 60% of the patients undergoing the Nesbit technique, restoration of a fully satisfactory coital activity was delayed because of pain during erection; 35% of all patients had some problems with the coronal suture which disappeared 1 month after the operation, and 15% reported decreased sensibility of the glans. Recurrence rate was not significant for all patients of all groups, even if 3 PD patients of the S-R plication group and 1 PD patient of the Nesbit group received no benefit from the operation. CONCLUSION: S-R plication is not better than the Nesbit procedure. However, for low degrees of penile bending, both congenital and acquired, we do not think it strictly necessary to perform the more invasive Nesbit operation (requiring opening of Buck's fascia, detachment of the neurovascular dorsal bundle or urethra and albuginea excision). Modified plication may be a minimally invasive and effective treatment suitable for most curvatures treated in day clinics and under local anaesthesia.

Dorsal tunica albuginea plication to correct congenital and acquired penile curvature: a long-term follow-up.

OBJECTIVE: To evaluate the long-term efficacy of a tunica albuginea dorsal plication technique for treating congenital and acquired penile curvature. PATIENTS AND METHODS: We retrospectively evaluated 83 patients (median age 1.8 years) who had their penile curvature corrected surgically using dorsal tunica albuginea plication between 1992 and 2002. The results were evaluated objectively using a pharmacological erection test or subsequently based either on the parents' reports or patients' self-assessment. The median (range) follow-up was 6 (0.7-10) years. RESULTS: Seventy (84%) patients had penile plication as an integral part of hypospadias repair, while the remaining 13 (16%) with a normal urethra had dorsal plication only. Twenty-eight (34%) of the 83 patients had an erection test during a repeat hypospadias repair or closure of a urethrocutaneous fistula; 22 of these had a straight penis, while the remaining six required additional plication for a satisfactory cosmetic outcome. Parents of 45 (54%) children reported that their child had a normal erection with no chordee during the follow-up. Ten (12%) adult patients reported straight erections enabling satisfactory penetration and sensation during sexual intercourse. None of the patients reported penile shortening or erectile dysfunction after surgery, and none had recurrent curvature during the follow-up. There was no difference in the results between patients with congenital or acquired penile curvature. CONCLUSIONS: Dorsal plication of the tunica albuginea is a simple and effective method in the long term for correcting congenital and acquired penile curvature.

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective.

OBJECTIVES: To investigate retrospectively the long-term functional results and quality of life of patients undergoing the Essed-Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire. PATIENTS AND METHODS: Between 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow-up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid. RESULTS: Of the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients' partners were satisfied with the outcome. CONCLUSIONS: The tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed-Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.

Corporeal herniation after Nesbit plication with partial thickness shaving for congenital penile curvature.

A 24-year-old man with penile congenital curvature who underwent partial thickness tunical shaving and plication with absorbable suture presented 1 month after surgery with a mass at the base of the right corpus cavernosum at the level of the original plication. We believe that corporeal herniation after tunical shaving and plication must be considered a complication of the technique independent from the type of suture used for the plicatures and probably related both to the opening of plications of the albuginea before permanent adhesion of the tunical layers, and to the decreased resistance of the albuginea, probably because of excessive shaving.

Successful use of tunica vaginalis grafts for treatment of severe penile chordee in children.

PURPOSE: Prior reports have suggested that tunica vaginalis free grafts for the treatment of chordee are associated with a high failure rate and residual curvature. We reviewed our experience with tunica vaginalis free grafts for the treatment of severe chordee associated with scrotal and perineal hypospadias. MATERIALS AND METHODS: The records of 25 children with scrotal or perineal hypospadias associated with severe ventral chordee requiring a corporal graft to straighten the phallus treated from 1996 to 2001 were reviewed. Of the cases 5 were reoperative due to prior failed urethroplasty and residual chordee. All patients undergoing primary surgery received testosterone treatment preoperatively. Dermis was used in 3 patients, small intestinal submucosa in 3 and a free graft of tunica vaginalis in the remaining 19. One child had 2 tunica grafts placed at the same setting to correct the chordee. RESULTS: Patient age ranged from 5 months to 16 years (median 8 months). All patients have been followed for a minimum of 1 year and a maximum of 5 years. All patients completed stage 2 repair of the hypospadias at which artificial erection was performed to detect residual ventral curvature. In only 1 patient with a prior failed hypospadias repair was there evidence of recurrent chordee after tunica vaginalis graft placement. This patient was treated with a dorsal plication at the time of urethroplasty. No other patient had evidence of residual or recurrent chordee. CONCLUSIONS: In our hands, tunica vaginalis grafting of the corpora has produced excellent results. It is a readily available material and easy to harvest in patients who require extensive perineal dissection at the first operation. Long-term followup of these children as they progress through puberty is needed.

Complications of small intestinal submucosa for corporal body grafting for proximal hypospadias.

PURPOSE: Small intestinal submucosa (SIS) has been described for corporal body grafting in cases of severe penile curvature. We reviewed our experience with a 2-stage repair using corporal body grafting with SIS for proximal hypospadias and severe chordee. MATERIALS AND METHODS: A retrospective chart review was performed on 12 patients with penoscrotal hypospadias and severe chordee. Corporal grafting was performed with a 4-layer SIS graft (STRATASIS, Cook Biotech, Spencer, Indiana). Patients were evaluated postoperatively with clinic visits after both stages of repair to assess results. RESULTS: Corporal body grafting with SIS was performed in 12 patients between June and December 2001. Average patient age at the time of stage 1 repair was 9 months. Of the 12 patients 8 (66%) had no complications and 10 (83%) have a straight phallus following stage 2 repair. Complications occurred in 4 patients (33%), 2 of which were minor and did not require surgical correction. There were 2 major complications related to the SIS graft, 1 of which required excision of the graft and replacement with a tunica albuginea flap, and the other required 3 dorsal plications to correct residual chordee. CONCLUSIONS: Our experience using the 4-layer SIS resulted in 2 major complications requiring surgical correction during stage 2 repair. This rate exceeds the complications reported with either dermal or tunica vaginalis grafts. Currently we have stopped using SIS for corporal grafting.

Proximal division of the urethral plate in staged hypospadias repair.

PURPOSE: We describe a new technique for staged hypospadias repair in which the urethral plate is divided proximally at the time of the first stage. MATERIALS AND METHODS: A total of 14 patients with proximal hypospadias associated with severe chordee were operated on using a new staged technique. At the time of the first stage the urethral plate was divided proximally at the level of the hypospadiac meatus. In 8 of 14 patients the intact plate was then incised and tubularized with the Snodgrass technique. In 6 patients the plate was tubularized at the time of the second stage. Correction of chordee was accomplished with dorsal plication and/or corporal body grafting. Byar's flaps were used to fill in the residual gap between the proximal hypospadiac meatus and the newly tubularized neourethra. The transposed flaps in the area of the urethral defect were then tubularized at the second stage. RESULTS: Followup ranged from 6 months to 3 years. Complications included a proximal pinpoint fistula and diverticulum in 1 case. An additional patient also had formation of a mild diverticulum that has not required surgical revision. No patients have had any evidence of distal urethral stricture formation. CONCLUSIONS: Proximal division of the urethral plate and application of the Snodgrass procedure to the staged repair of hypospadias have resulted in improved functional and cosmetic results. The major advantage of this new technique is preservation and use of the native urethral plate in the glans and subcoronal area. When complications occur with this technique, they are less severe compared to those of the traditional staged approach.

Single layered small intestinal submucosa in the repair of severe chordee and complicated hypospadias.

PURPOSE: Severe ventral chordee often accompanies proximal hypospadias. We describe our experience with single layered small intestinal submucosa (SIS), a commercially available, acellular, collagen based biomaterial, in the repair of severe chordee as part of a multistage approach to the repair of proximal hypospadias. MATERIALS AND METHODS: Between 2001 and 2002, 9 boys with proximal hypospadias (penoscrotal to perineal) and severe ventral chordee (greater than 40 degrees) underwent SIS grafting to correct the curvature. In each case the urethral plate was transected at the point of maximal curvature, the defect in the corporal bodies was measured, and the SIS graft was cut 2 mm wider around the perimeter of the defect and sutured into place. Skin resurfacing of the ventral penis was performed in standard fashion using Byars flaps. Recurrence of chordee was assessed by an artificial penile erection test at the time of stage 2 reconstruction. RESULTS: Of the 9 boys 8 underwent a planned 2-stage repair with subsequent urethroplasty 6 to 12 months after the initial stage 1 chordee repair. Median age at stage 1 repair of the 8 boys was 9 months. Native meatus location was penoscrotal in 6 boys, mid scrotal in 1 and perineal in 1. A 14 month-old boy underwent 1-stage chordee correction with SIS and a transverse preputial island tube graft urethroplasty for penoscrotal hypospadias. There were no perioperative medical or surgical complications related to use of SIS for chordee repair. Median age of the 8 boys at stage 2 repair was 18 months. At stage 2 the graft site was supple and smooth without significant scarring. All chordee correction has remained durable with followup ranging from 16 to 21 months. Postoperative complications occurred in 3 cases, including meatal stenosis requiring meatoplasty, subcoronal fistula requiring repair and complete breakdown of the neourethra in the single stage repair case. CONCLUSIONS: Although this study includes a small population of patients and has limited followup, our favorable experience with single layer SIS suggests that it is a safe and effective, commercially available material for corporal body grafting to correct severe chordee as part of a multistage surgical approach to repair complex hypospadias. A larger series of patients with longer followup is necessary to determine if the chordee correction remains durable. Our experience is insufficient to judge its efficacy in single stage repairs.

Tunica albuginea plication for the correction of penile curvature.

OBJECTIVE: To evaluate the efficacy of tunica albuginea plication (TAP) in the correction of congenital and acquired penile curvatures and determine key points for a successful outcome of this procedure. MATERIALS AND METHODS: From December 1995 to January 2001, 40 patients with penile curvature (10 congenital and 30 secondary to Peyronie's disease) underwent surgical correction by TAP. Indications were difficult or impossible penetration, normal erectile function, stable disease. For TAP we used non-absorbable inverted stitches tied with the assistant pushing down the tunica albuginea with a mosquito clamp to create an adequate groove for the knot. The results were evaluated subjectively and objectively. RESULTS: At mean follow-up of 30 months, full subjective and objective success (straight penis, mild shortening, normal erection, penetration and sensation) was achieved in 37 (92.5%) patients. Objective but not subjective success was achieved in 2 patients (5%), 1 complaining of psychogenic erectile dysfunction and the other of excessive penile shortening. There was only one failure, namely persistent glans numbness due to damage of the non-mobilized neurovascular bundle. CONCLUSIONS: TAP is a simple and effective method for the correction of congenital and acquired penile curvatures. Key points for successful outcome are adequate preoperative evaluation and counselling, careful preparation of tunica albuginea, mobilization of urethra or neurovascular bundle when needed, use of inverted stitches carefully buried, objective postoperative evaluation with a pharmacological erection test.

The correction of penile curvature with the Essed-Schröder technique: a long-term follow-up assessing functional aspects and quality of life.

OBJECTIVES: To investigate, in a retrospective analysis using a detailed questionnaire, the long-term functional results in and quality of life (QoL) of patients after undergoing the Essed-Schröder procedure, a standard technique for correcting penile curvature. PATIENTS AND METHODS: From 1994 to 1999, 40 patients (median age 24 years) had their penile curvature corrected using a modified Essed-Schröder technique. Assessments by the investigators and a self-completed questionnaire were used to evaluate the functional and cosmetic aspects of the procedure, and QoL issues. RESULTS: Complete follow-up data were available in 31 of the 40 (78%) patients (19 with congenital curvature and 12 with Peyronie's disease). The median follow-up was 22 months. The degree of penile angulation before surgery was estimated as < 45 degrees in five patients, 45-90 degrees in 22 and > 90 degrees in four. In 21 patients (68%) sexual intercourse was uncomfortable or impossible; 26 (84%) reported an impaired QoL because of the penile curvature. After surgery the cosmetic and functional result was good or sufficient in 25 patients (81%); all 25 were able to have sexual intercourse with no problems. Penile shortening (> 2 cm) was reported by six patients. A significant improvement in QoL was reported by 15 patients (48%), but of the 12 patients with Peyronie's disease before surgery, six reported impaired rigidity and two recurrence of their penile curvature afterward. Whereas only seven of 12 patients with Peyronie's disease reported good functional results, 18 of the 19 with congenital curvature reported good or excellent results after surgery. CONCLUSION: The Essed-Schröder method is a simple operation which provides good functional and cosmetic results. Patients with congenital curvature of the penis have better results than those with Peyronie's disease.

[Treatment by a modified plication of the tunica albuginea in patients with congenital penile curvature]. / Tratamiento con plicatura modificada de la túnica albugínea en pacientes con incurvación congénita peneana.

OBJECTIVE: To evaluate the results obtained with management by modified plication of the tunica albuginea in patients with congenital penile incurvation. MATERIAL AND METHODS: Between January 1992 and December 1996, a modified plication technique of the tunica albuginea was used to correct congenital and acquired penile incurvations; the procedure was performed in 27 cases of patients with congenital penile incurvation and 17 patients with de la Peyronie's disease. Mean age was 22.8 years (range 15-40 years), single ventral incurvation being the most frequent (51.8%) type. A modified technique of tunica albuginea plication was used. RESULTS: Complete correction of the incurvation was achieved in all patients (100%), with a low rate of complications. CONCLUSIONS: Modified plication of the tunica albuginea is a simple and effective surgical technique to achieve correction of congenital penile incurvations.