Orthoplasty

Orthoplasty is a reconstructive surgical procedure typically aimed at correcting deformities or restoring function and appearance to a body part. The term is broad and applies to different specialties depending on the body area being treated. Common contexts for orthoplasty include penile orthoplasty for correcting congenital or acquired penile curvature and orthoplasty for orthopedic joint corrections. Below is an overview of the most common application: penile orthoplasty, often performed for conditions like Peyronie’s disease or congenital curvature.

Indications for Penile Orthoplasty

1. Peyronie’s Disease:
   • Curvature of the penis due to fibrous plaque formation.
2. Congenital Penile Curvature:
   • Developmental abnormality present at birth.
3. Post-Traumatic Deformity:
   • Injury leading to a bent or deformed penis.
4. Severe Functional Impairment:
   • When curvature affects sexual function or causes pain during intercourse.

Preoperative Preparation

1. Detailed Evaluation:

   • History: Assess duration, severity, and impact on function or quality of life.
   • Physical Examination: Check for palpable plaques (in Peyronie’s disease) and degree of curvature.
   • Imaging: Penile ultrasound or dynamic infusion cavernosometry to evaluate plaques, blood flow, and rigidity.

2. Patient Counseling:

   • Explain the goals, risks, and expected outcomes of the surgery.
   • Discuss postoperative recovery, activity restrictions, and potential complications.

3. Anesthesia:

   • Surgery is typically performed under general or regional anesthesia.

Surgical Techniques

The choice of technique depends on the severity of the curvature and whether erectile function is preserved.

1. Plication Surgery:

• Best for mild to moderate curvatures (<60 degrees).
• Involves shortening the longer side of the penis (opposite the curve) by folding and suturing the tunica albuginea (outer layer of the penile shaft).
• Pros: Minimal risk of erectile dysfunction.
• Cons: May cause slight penile shortening.

2. Plaque Incision and Grafting (for Peyronie’s Disease):

• Suitable for severe curvature or plaques with significant penile shortening.
• The plaque is incised or removed, and the defect is covered with a graft (e.g., synthetic, autologous, or allograft materials).
• Pros: Straightens the penis and preserves length.
• Cons: Higher risk of erectile dysfunction.

3. Penile Prosthesis Placement:

• For patients with severe curvature and concomitant erectile dysfunction.
• Prosthesis insertion can straighten the penis while addressing erectile issues.
• Pros: Simultaneous correction of curvature and ED.
• Cons: Involves more extensive surgery.

Postoperative Care

1. Hospital Stay:

   • Usually discharged the same day or after 1-2 days.

2. Pain Management:

   • Analgesics and anti-inflammatory medications to control pain and swelling.

3. Catheter Care:

   • A urinary catheter may be placed temporarily for drainage.

4. Activity Restrictions:

   • Avoid sexual activity, heavy lifting, and strenuous activities for 4-6 weeks.
   • Regular stretching exercises may be recommended to optimize outcomes.

Benefits

• Restores the functional and cosmetic appearance of the penis.
• Improves sexual satisfaction for both the patient and their partner.
• Resolves pain associated with curvature.