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Text Atlas of Penile Surgery

2007 Edition, December 13, 2007

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Active, Most Current

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ISBN: 978-0-203-00719-8
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Product Details:

  • Revision: 2007 Edition, December 13, 2007
  • Published Date: December 13, 2007
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 242
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Many men see the shape and function of their penis as a scale with which they measure their health and manhood. The development of a deformity or dysfunction in the previously healthy penis causes great concern to men. Also, abnormalities of the external genitalia are troubling for parents because of the possible impact on the future psychosexual development of the child.

Penile deformations are more frequent than expected. The effect of deformations and abnormalities on patients' erectile ability is variable. Most congenital anatomical penile abnormalities do not cause erectile dysfunction. Usually patients are fully able to reach a rigid erection. While in some patients the erectile ability does not change as a result of the deformity, the abnormal shape of the penis may cause severe functional sexual difficulties for the patient or couple. In some cases the abnormal shape of the penis makes penetration difficult, or may cause discomfort or even pain to the partner. As a result of the anomaly a chain reaction starts to develop: the sexual dysfunction later can become a psychosexual dysfunction which may lead to erectile dysfunction. In some acquired deformities the disease may have a direct effect on the erectile ability. Most acquired penile deviations are the result of Peyronie's disease that by itself can cause erectile dysfunction. However, during the period in which intracorporeal injections for achieving an erection were much more common than today, and as a sequela to these injections, during the past decade we have started to see deviations caused by repeated intracorporeal vasoactive drug injections in patients already having erectile dysfunction.

While abnormalities of the placement of the urethral meatus are not considered to be uncommon, congenital erectile curvature without hypospadias or epispadias is still believed to be rare. However, in practice we know that non-hypospadic deformities of the penis are more frequent than expected.

With increasing awareness among physicians and the general public, and the good to excellent results obtained with their repair, surgical treatments of penile deformities are becoming established procedures. Although during many decades an abundance of hypospadias repair techniques were described in the medical literature, only after the late 1970s did a few articles on non-hypospadic deformity cases and techniques for their repair start to be published. In many cases, the relative ease of achieving a cosmetically acceptable penile appearance drives patients or their families to apply for surgical correction of the deformity or dysfunction.

Congenital penile curvatures can be diagnosed even in childhood, usually by the parents. These curvatures reflect the curvatures we encounter in adulthood.

Preputial problems such as phimosis or paraphimosis in adults are rarely seen in countries where ritual circumcision is common. However, preputial adhesions as well as phimosis and paraphimosis can be seen before the child is circumcised.

Various degrees of hypospadic deformities are frequently seen in all urological clinics; however, epispadias or extrophy–epispadias complex cases are quite rare.

In clinics specializing in penile deformities, it is fairly common to see adults who have undergone unsuccessful hypospadias repairs in less experienced hands. These hypospadias cripples are the difficult cases to treat because of the repeated previous surgical repair attempts.

Severe cases of congenital malrotation of the penis are uncommon. It is generally a cosmetic defect in which the meatal slit is not realigned with the scrotal raphe. Mild cases of this anomaly can be seen in many children. Penile malrotation does not cause a sexual dysfunction; however, parents of these children and sometimes patients apply for its correction.

In the past, gonococcal anterior, especially penile urethral strictures were common all around the world. Although this complication is now rarely seen in developed countries, it is relatively common in developing countries, where venereal diseases are still undertreated. Today, most anterior urethral strictures are traumatic, iatrogenic, or the result of indwelling catheterization, and are mostly situated in the bulbar urethra.

Many men who are not happy with their penile size or have heard that the penis can be enlarged apply to urologists to add length and girth to their penile dimensions. However, there are no sufficient references in the medical literature supporting a safe and efficacious method for purely cosmetic augmentation phalloplasty surgery. Unfortunately, the expectations of patients from such surgery are far greater than the actual results. Although some surgeons still think that people who apply for an augmentation phalloplasty need a psychiatrist instead of a surgeon, there is quite a large group of men who really need penile cosmetic surgery, not only for augmentation but also for other penile deformities.

Almost all penile deformations are surgically treatable conditions; however, not every penile deformation needs to be treated. Because of the possible psychosexual consequences, it is advisable to correct most congenital deformations in children and adolescents. In acquired deformations, if the patient has a stable sexual relationship, if he can penetrate without difficulty, and if both partners enjoy the sexual act, in many cases there is no need for surgical correction.

The aim of this book is to provide practical surgical solutions to congenital or acquired penile anomalies and diseases for the practicing urologist who encounters them in daily practice, the way in which to approach these patients, how to evaluate them, and so on. Starting with surgical anatomy, I have tried to give easy-to-follow practical details of the procedures I perform to ensure successful outcomes. In addition to the schematic drawings accompanying the chapters, I have inserted ‘real-life' photos of cases, to show less experienced surgeons that after surgery the penis does not appear exactly as in the drawings. This is not a ‘cook book'. I have tried to present the principles of the surgical procedures that I perform. The reader can view the book as surgeon-to-surgeon advice.

The book includes the surgical anatomy of the penis and descriptions of the commonly used operative procedures, as well as the surgical procedures for many uncommon penile pathologies. I have also added the tricks and gimmicks I use, and the surgical techniques that I have developed or modified during the long years of my practice. Most of the material in this book is based on an experience of more than 30 years in the field of penile and urethral surgery, and the experience accumulated in the Penile Deformations Unit of the Department of Urology at the Hillel Yaffe Medical Center in Israel, which I founded more than two decades ago. Some of the figures appearing in the book were drawn during these years and were a part of my surgical drawings collection. Most of the rest were drawn for the purpose of illustrating this book. The photos also come from my personal collection, and I know that not all are perfect in their quality. I hope that readers will show an understanding for the quality of some of the photos taken many years ago.

My hope is that this book will become the resource to review before certain surgical procedures are performed on the penis as a part of the presurgical preparation by the practicing urologist.