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STAGE Technique for Congenital Penile Curvature

In your practice, you might meet patients with congenital penile curvature. Men with this condition were born with a distinct curve in their penis, the result of a problem in fetal development.

Congenital penile curvature can cause a number of issues for men, including difficulties with vaginal penetration, erectile dysfunction, and problems with sexual confidence and self-esteem.

Surgery can correct the curvature. However, there can be complications, such as shortening of the penis, loss of sensation, and erectile pain.

Dr. Paulo H. Egydio and Dr. Franklin E. Kuehhas, both from the Advanced Center for Penile Curve Treatment located in Brazil and Austria, developed a new procedure designed to treat congenital penile curvature.

Called the STAGE (Superficial Tunica Albuginea Geometric-Based Excision) technique, the procedure uses geometric principles to straighten the penis. According to the doctors, the STAGE technique has a 98.6% success rate and improves sexual function and satisfaction.

Today, we’ll take a closer look at the STAGE technique and the outcomes that have been reported.

The STAGE Technique: Four Steps

To prepare for the surgery, the patient is sedated and given local anesthesia. The penis is then degloved, a process that involves peeling back the skin to expose the internal tissue.

At this point, the STAGE technique is a four step process:

1.   Using geometric principles, surgeons examine the convex side of the bent penis and locate the area where it curves the most.

2.   Surgeons move the neurovascular bundle – the layer of tissue that holds the penile sensibility nerves. This allows access to the outer layer of the tunica albuginea, the sheath surrounding the tissue inside. Three small excisions (3 mm each) are then made at the point of maximum curvature found in Step 1.

3.   The excisions are closed with absorbable sutures.

4.   Steps 1, 2, and 3 are repeated until the penis is straight.

For three to six months after surgery, penile physical therapy and regular stretching are recommended.

STAGE Technique Outcomes

In October 2013, Drs. Egydio and Kuehhas published a study on the STAGE technique online in the Journal of Sexual Medicine. In their report, they discussed the effectiveness and safety of the procedure based on their retrospective analysis of 145 patients.

The men had STAGE surgery between June 2006 and March 2012. Their mean age was 23.8 years. Before surgery, their penile curvature ranged from 45 to 90 degrees, with a mean of 65 degrees. About 35% of them had trouble with vaginal penetration and 43% of them had pain with intercourse (dyspareunia).  

After surgery, none of the men had a significant recurrence. Nine of them still had a residual curve of up to 20 degrees, but were still satisfied with their results and did not ask for a second operation. Two men had residual curves over 30 degrees. These men did have follow-up surgery.

Dyspareunia – for both men and their partners – went away within six months of the procedure.

Penile shortening was slight, with a mean of 0.7 centimeters. There were no significant complications during the procedure or recovery period.

Many men reported improved libido, greater sexual and relationship satisfaction, and increased sexual confidence after surgery.

Benefits of the STAGE Technique

On their website, Drs. Egydio and Kuehhas compared the STAGE technique to alternative methods. They noted that compared to the Nesbit procedure (a common technique), STAGE patients lost less penile length and had reduced risk for hematoma and erectile dysfunction. Sutures could not be seen or felt and had little potential for bleeding, rupture, or irritation. Patients undergoing STAGE were also less likely to lose penile sensation.

The STAGE technique offers men with congenital penile curvature another surgical treatment option. If your patients are interested in this technique, they should discuss it with a urologist.


Print this article or view it as a PDF file here: STAGE Technique for Congenital Penile Curvature

Resources

Advanced Center for Penile Curvature Treatment

“STAGE : ​Superficial Tunica Albugina Geometric-based Exicison (sic) for the correction of Congenital Penile Curvature”

http://www.acpct.com/#!stage-technique-curved-penis/c1qiu

The Journal of Sexual Medicine

Kuehhas, Franklin Emmanuel, MD and Paulo Henrique Egydio, MD, PhD

“The STAGE Technique (Superficial Tunica Albuginea Geometric-Based Excision) for the Correction of Biplanar Congenital Penile Curvature”

(Full-text. First published online: October 24, 2013)

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12346/full