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14 ture line connecting the two tunical incisions (modi ed corporplasty), or fashioning a longitudinal incision and closing it in a Heineke Miculicz fashion transversely (Yacchia procedure) The advantages of these procedures are that the repair heals by primary intention However, the repair does require an incision in the tunica, thus theoretically putting erectile tissue at risk The Nesbit procedure was originally developed for congenital curvature It is worth noting at this juncture, that many series reporting outcomes of this procedure have included patients with both Peyronie s disease and congenital curvature These are non-identical conditions and caution in interpreting these series is warranted First, the tunica albuginea of young men with congenital curvature is not diseased, as is the case in Peyronie s disease, and generally they have excellent penile stretch and do not have penile length loss at presentation Second, congenital penile curvature results from corporal disproportion and most men have a gentle bowing of the penis without any speci c point of angulation Imbrication procedures do not involve making a tunical incision but rather fold the tunica, thus the integrity of the curvature correction is dependent upon the strength of the suture used to imbricate the tunica (Essed Schroeder, 16-dot procedures) A review of outcomes for tunical incising (Nesbit type) procedures for Peyronie s disease is presented in Table 141 A review of outcomes for imbrication procedures for Peyronie s disease and congenital penile deviation are presented in Tables 142 and 143 Tunica-incising plication procedures may give better long-term results than imbrication procedures in the correction of penile deformity in Peyronie s disease

preoperatively is an essential part of preoperative evaluation and this can be accomplished with either duplex Doppler penile ultrasound or dynamic infusion cavernosometry It is recommended that an adequate assessment of penile deformity and erectile hemodynamics be performed prior to surgical reconstruction

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when small amounts of money are involved they do not seek care at all Forgoing basic annual physicals can allow medical conditions to go unnoticed and untreated until they become much bigger problems For example, one study showed that even a $10 copay (the amount a patient is responsible for covering) caused a signi cant reduction in the use of mammograms, despite the fact that paying for a mammogram now is immeasurably cheaper than treating cancer down the road38 Another study found that targeted prevention used to control hypertension among seniors could save Medicare $890 billion over 25 years39 Consider by contrast the socialized medical system of the United Kingdom, where the National Health Service (NHS) provides most medical services, although private services are available Routine care is largely the responsibility of general practitioners, who are typically private doctors that contract with the NHS; they are paid by the NHS according to work they do and their performance Patients pay a xed fee for each drug prescribed regardless of the amount of drug prescribed or the cost to the pharmacy; the cost of drugs is charged to the NHS General practitioners can refer their patients for more specialized treatment While the UK system has its detractors who claim the system discourages hospital purchase of specialized equipment and increases wait times for critical care, overall satisfaction rates are high Because routine and preventative care is largely free of cost, the United Kingdom also avoids some of the problems of cost-conscious citizens failing to seek preventative care In the United States, a transition to a UK-style socialized medicine system is not only contentious but unlikely Yet rede ning the public sector s contribution to health care is necessary to x what ails American health care The public sector could increase immunization and screening programs and introduce more convenient care clinics that grant access to nurse practitioners and other medical professionals for quick advice and other prevention measures.

The literature contains some observations of marked improvement of sexual dysfunctions associated with HPRL following non-speci c treatments such as psycho- or sex-therapy [250] or, as concerns ED, sildena l [241,253] However, PRL-lowering dopamine-agonists (bromocriptine, lisuride, quinagolide, and cabergolide, the latter one being effective following a single administration per week) [254] most often not only normalize all aspects of sexual function, but also shrink the possible pituitary ade-

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