Presentation Authors: OLIVER RALPH*, Mattia Anfonso, Nikita Shroff, GIDEON BLECHER, NIM CHRISTOPHER, David Ralph, Chesham, United Kingdom
Introduction: The function of the penile suspensory ligament (PSL) is to provide support to the erect penis to and maintain an appropriate angle for sexual intercourse, This paper describes the management of congenital and acquired abnormalities of the PSL.
Methods: A total of 124 patients that presented with a variety suspensory ligament abnormalities necessitating repair are included. The aetiology included: subsequent to sexual trauma (n=68), congenital penile curvature/ torsion (n=33), absence/laxity of the ligament (n=6), Peyronieâ€™s Disease (n=8), venogenic erectile dysfunction (n=7) and penile dysmorphic disorder (n=2). The diagnosis was made clinically via a history and examination, instability on artificial erection testing and the presence of a palpable gap between the pubis symphysis and penis. Psychogenic ED was excluded using nocturnal rigiscan monitoring. The surgical repair involved placement of non-absorbable sutures between the tunica albuginea of the penis in the midline and the symphysis pubis. Ancillary procedures of plication/grafting or venous ligation was also performed in 41 patients.
Results: The mean age (range) of the patients was 29 years (12-60 years) and mean follow up was 8 months (1 mth - 12 years).A good surgical result was achieved in 82% of patients as defined by stabilisation of the penis, a return to good sexual function and a straight cosmetic result. Overall 77% of patients were happy with the outcome. The main reason for dissatisfaction was residual curvature , mainly in the congenital curvature and sexual trauma groups although this was only >25 degrees in 5 patients. Complications included de novo ED in 2 patients and chronic pain in 2. Also revision repair was required in 15 patients at a later date mainly due to early recommencement of sexual intercourse.
Conclusions: There are a range of manifestations of penile suspensory ligament damage, leading to a variety of clinical presentations. However if correctly diagnosed a good cosmetic and functional result is usually achievable