Correction Of Recurrent Penile Curvature Using Midline Sutures And Demonstrating Shaeer’s Square Knot

Shaeer, O,

The Double Chop Incision An Easy Open and Close Penoscrotal Access for Penile Prosthesis Implantation (2)

This video demonstrates correction of recurrent ventrolateral penile curvature. The bi-directional curve is corrected using a single midline suture. Shaeer’s Square Knot is demonstrated. Skin incision is cut in the former scar along the circumcision line. Dartos muscle is dissected off Buck’s fascia, resecting adhesions from the previous surgery using bipolar scissors. Sutures from the previous repair are removed. Artificial erection is induced, identifying the point of maximum curvature (PMC). Buck’s fascia is incised over the deep dorsal vein (DDV). A 2/0 polyester suture is passed into the tunica albuginea on one side of the PMC, from proximal to distal. This is right next to the DDV where no nerves are coursing 1. The sutures is passed into the tunica of the contralateral corpus cavernosum, on the other side of PMC, across the deep dorsal vein and right next to it, again from proximal to distal. This should invert the knot. Since the suture line is diagonal, it corrects both directions of the curvature (ventral and lateral) in one step. The suture is tied with the penis manually oriented straight, and the midpoint of the area to be plicated dipped-in. This dipping-in should minimize the shortening. The knot is inverted. Following this step, the penis is straight with no loss in length. Upon patient’s request, overcorrection is performed to the dorsal direction, using Shaeer’s Square Knot. This knot distributes the points of entry and exit over several planes to minimize the possibility of tearing through the longitudinal fibers of the tunica, thereby decreasing recurrence. It is passed on one side of the PMC, then on the other side of PMC travelling sideways for 3-5 millimeters, then back to the first point, though 3-5 millimeters away. The knot is tied and inverted. Dartos and skin edges are freshened and sutured closed.

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[1] Shaeer OK. Shaeer's Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis. Plast Reconstr Surg Glob Open. 2016;4: e1019.