The effectiveness of penile curvature treatment by cavernous body rotation and plication of the tunica albuginea

**Background:** Penile curvature, whether congenital or acquired, impairs copulatory function. Surgical approaches include tunica albuginea plication (TAP), corpus cavernosum rotation (CR), and graft techniques. TAP has reported efficacy of 90–100% in the first year but is associated with penile shortening (26.6–80%), glans numbness (8.3%), and curvature recurrence (35–48%). CR techniques offer high efficacy (~90–100%) with less shortening (~5 mm) but may reduce penile girth. This study directly compares TAP and CR outcomes.

**Methods:** A prospective, double-blind, randomized trial was conducted at two hospitals in Irkutsk, Russian Federation (2017–2020). Inclusion criteria: adult men with congenital or idiopathic penile curvature (ventral/dorsal/lateral), completed IIEF-5 assessment. Exclusion criteria: Peyronie's disease, complex curvature, curvature <20 degrees, moderate/severe erectile dysfunction, prior penile surgery. Patients were randomized to CR (Shaeer's CR III) or TAP (Nesbit medial modification). Primary endpoint: freedom from Clavien-Dindo complications >1. Secondary endpoints: IIEF-5 ≥21, postoperative curvature <10 degrees, restored glans sensitivity, ≥3 months follow-up. Curvature was measured by protractor; penile length and girth by flexible tape. Statistical analysis used STATISTICA 10.0, SPSS 23.0, and Stata 16.0, with significance at p≤0.05.

**Key Results:** Of 35 enrolled patients, 22 completed per-protocol analysis (9 CR, 13 TAP). Groups were comparable at baseline: mean age 27.4 vs 28.2 years (p=0.858), mean curvature angle 48.8° vs 48.2° (p=0.924), mean erect length 16.7 vs 16.1 cm (p=0.473), mean girth 13.3 vs 12.8 cm (p=0.523). Both techniques eliminated curvature (postoperative angle 1° in both groups, p<0.001) and improved IIEF-5 scores (from 21 to 25 in both, p<0.001). CR resulted in mean shortening of 0.6 cm (p=0.470) and girth reduction of 1.2 cm (p=0.119). TAP caused significant shortening of 2.4 cm (p=0.006) and girth reduction of 0.3 cm (p=0.585). Shortening >1 cm occurred in 0% of CR vs 92.3% of TAP (p=0.009). Girth reduction >1 cm occurred in 88.8% of CR vs 0% of TAP (p=0.003). Palpable induration occurred in 0% CR vs 46.1% TAP (p=0.057). Glans numbness >3 months: 11.1% CR vs 15.3% TAP (p=0.801). Subjective satisfaction: 100% CR vs 84.6% TAP (p=0.789). Good composite outcomes: 88.8% CR vs 69.2% TAP (p=0.577). Univariate logistic regression identified preoperative curvature >60° as a significant predictor of subjective penile shortening in TAP (OR 2.7; 95% CI 0.12–5.28; p=0.040). Predictors of palpable induration included weight (OR 0.17; p=0.027), change in penile length (OR 2.1; p=0.021), shortening >2 cm (OR 2.7; p=0.029), and postoperative girth (OR 0.88; p=0.031).

**Clinical Implications:** Both CR and TAP are safe and effective for penile curvature correction with minimal complications. The choice of technique should be individualized: TAP is not recommended for patients with preoperative curvature >60° due to significantly higher risk of subjective shortening. CR is preferred when preserving penile length is a priority, though it reduces girth more than TAP. Patients should be counseled about these trade-offs. Limitations include small sample size, single-center design, and mean follow-up <5 years. Further research with larger samples is needed to refine patient selection and optimize outcomes.