OPERATION DATE: 03/25/2019 PREPROCEDURE DIAGNOSIS: Congenital penile curvature. POSTPROCEDURE DIAGNOSIS: Congenital penile curvature. PROCEDURES PERFORMED: 1. Tunica albuginea plication. 2. Artificial erection. SURGEON: Wayne Hellstrom, MD ASSISTANT: Thomas Shelton, MD (R) ANESTHESIA: General. INDICATIONS FOR THE PROCEDURE: Mr. Miranda is a 29-year-old gentleman with a lifelong history of an approximately 35-to 40-degree ventral penile curvature. The patient wished to have this surgically corrected. He was counseled on his options for straightening maneuvers and elected to proceed with a penile plication. The risks and benefits of surgery were discussed with the patient and he agreed to proceed. OPERATION IN DETAIL: The patient was seen in the preoperative unit and informed consent was verified. The risks and benefits of surgery were again discussed with the patient. He wished to proceed. The patient was then taken to the OR and placed in supine on the operating room table. After a smooth and uneventful induction of anesthesia, the patient was prepped and draped in sterile fashion. A WHO timeout was performed and all were in agreement. We began by making a circumferential incision approximately 1 cm proximal to the corona with a 15 blade scalpel. We dissected down to the level of Buck's fascia using 15 blade. We then proceeded to deglove the penis entirely. Once the penis was degloved, we used a combination of bipolar and Bovie monopolar electrocautery to obtain adequate hemostasis. Once hemostasis had been achieved, we took a 21-gauge butterfly needle and inserted into the lateral aspect on the base of the penis. We then injected approximately 80 mL of sterile saline into the penis to induce an artificial erection. This revealed approximately 35-degree ventral curvature. Once we identified the curvature, we elected to perform a penile plication procedure. In order to do this, we made a small incision in Buck's fashion to expose the tunica albuginea. This was dissected down to reveal an adequate spot for placement of plication sutures. We then proceeded to place a series of 3 separate plication sutures contralateral on the right, slightly dorsal aspect of the right corpora. We used 2-0 Ethibond suture to place the stitches. Once the stitches were placed, we reinjected the sterile saline in order to assess the straightness the erection. At this point in time, we assessed that there was less than 10-degree curvature. We then closed Buck's fascia using 3-0 Monocryl suture in a figure-of-eight fashion. We then reapproximated the penile skin with 3-0 Monocryl suture in a simple-interrupted fashion, getting in a 4-quadrant fashion and then length circumferentially around the incisions. Once the skin had been adequately exposed, we applied collodion to the incision site. We then placed a Xeroform dressing over that. A Kling wrap was applied on the penis and a Coban dressing was wrapped as a final step. The patient was then awoken from anesthesia and taken to the PACU in good condition. Dr. Wayne Hellstrom was scrubbed and present for the entirety of this case. DISPOSITION: The patient will be observed in PACU until alert and awake and to be discharged to home this afternoon.