Prof Daniar Osmonov, Ragheb Ahmed

(35) THE KIEL KNOTS TECHNIQUE FOR THE TREATMENT OF CONGENITAL AND ACQUIRED PENILE CURVATURE

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives We propose a surgical technique for the correction of both congenital and acquired penile curvatures. Our technique is based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques by burying the knots in shallow troughs of the incised tunica albuginea. We entitle this modification as the “Kiel Knots”. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach. Methods A circumcising incision is made and the penis is degloved. Buck’s fascia is then incised exposing the tunica albuginea opposite to the curvature. Eight dots 5mm apart are marked bilaterally on the tunica albuginea with the point of maximum curvature in the center and a 5 mm superficial transverse incision is made along each mark without cutting into the corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification entails utilizing a separate suture for every two dots with the knot being buried in the shallow trough we created by the scalpel. Results Our average operative time is an hour. An average loss of penile length of 0.5-1cm has been reported in 30% of our patients. All our patients preserved their erectile function. 90% of our patients remained without recurrence of curvature after 2 years of surgery. None of our patients reported problems with their suture knots. Conclusions Our technique achieves penile straightening with minimal loss of length and no erectile dysfunction. We believe that the “Kiel Knots” technique combines the best of Lue’s 16 dot technique together with the Essed-Schroeder plication technique while avoiding the downsides of both approaches. Conflicts of Interest The authors have no conflict of interest.

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