What to Expect From Peyronie's Disease Surgery

There are several different types of surgery for Peyronie's Disease

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Peyronie's disease is characterized by curvature of the penis. Scar tissue formation on the inside of the tissue causes the damaged areas to become less flexible. During an erection, the penis curves towards the area of the scar. This curvature can be, but is not always, painful. However, even if the curvature is not painful it can make sexual penetration uncomfortable, difficult, or impossible. For someone who enjoys sexual penetration, this can necessitate surgical correction. Although Xiaflex is approved by the U.S. Food and Drug Administration (FDA) as a treatment for Peyronie's disease, it is not always available or appropriate. Therefore, surgery may be a better option.

Before Getting Surgery for Peyronie's Disease

Not every person with Peyronie's disease is an appropriate candidate for surgery. In many cases, early signs of Peyronie's disease may resolve on their own. They may also not be severe enough to require surgery.

Surgery for Peyronie's disease is generally only recommended once the curvature of the penis has been stable for at least 3 to 6 months, and symptoms have been present for at least a year.

At that point, if penile curvature is sufficient to cause difficulty with penetrative sex, and penetrative sex is a priority, surgery may be recommended.

Because of these requirements for surgery, men seeking care for Peyronie's disease should expect to undergo a detailed sexual history. This will usually include a discussion of the extent of symptoms and how those symptoms have affected his sex life.

There will also be physical examinations. These are usually done both when the penis is flaccid and when it is erect. If it is difficult or impossible for someone to get an erection in the office setting, medication may be used to cause an erection artificially. This allows the doctor to observe the extent of penile curvature and the nature and location of any scarred areas.

Plication

Plication is the least invasive form of surgery for Peyronie's disease. In this procedure, stitches are placed on the opposite side of the penis from any scarring.

The goal is to shorten the penis on the far side of the curve so that the penis is pulled straight. In other words, the penis is shortened the same amount on both sides - once by scarring, once by plication.

The benefit of plication is that the risks of serious side effects, such as nerve damage or impotence, are relatively low. However, the penis is, by definition, shortened by the procedure.

Plication is usually done as an outpatient procedure, and men can generally go back to work the next day, or two days later. They are taught to change their dressings, and will do dressing changes at home for five days.

Like many outpatient surgeries, plication is done under sedation rather than under general anesthesia. Local anesthetic is also used to keep the patient from feeling pain.

In addition, plication can not be used for hourglass deformities or indentations.

Other potential issues with plication include:

  • Decreased sensation in the penis
  • Pain that persists after surgery
  • Bumps or lumps in the penis
  • A less rigid erection
  • The fact that any indentations in the penis will remain
  • The fact that the penis can become curved again

Plication is generally only used if the curvature of the penis is less than 60 to 70 degrees.

Excision and Grafting

In an excision and grafting procedure to treat Peyronie's disease, the scarred area of tissue is cut out of the penis. It is then replaced with a tissue graft. The type of tissue used for the graft will depend on a variety of factors, including the surgeon performing the procedure. This procedure may also be known as incision and grafting, or just grafting.

Surgical grafting is a much more invasive treatment than plication. It is a longer procedure that is usually done either under general anesthesia or with an epidural. The risk of nerve damage and/or impotence are also much higher.

Unlike plication, grafting restores length to the penis rather than causing the penis to become shorter. The goal is to make the short side of the penis the same length as the long side.

This is the opposite way from how plication reverses the curve.

Because incision and grafting is more invasive and may require multiple incisions depending on the type of graft, it usually requires an overnight hospital stay. There is also a longer recommended recovery time before people can resume engaging in sexual intercourse, and men may need to stay out of work for a few days.

In addition, penile stretching and massage may be recommended to help restore shape and length. Men may also be instructed to use a penile traction device.

Grafting can be used for men whose penile curvature is greater than 60 to 70 degrees. Unlike plication, it can also be used if the penis is indented or there is a risk of the penis bending around a destabilized area, like a hinge.

Penile Implant

Both plication and grafting are options best suited to men who are still capable of getting an erection. That's true even if getting an erection requires the use of medication or a vacuum pump. However, if a man with Peyronie's disease is unable to get an erection, even with assistance, a penile implant may be the only option.

Penile implants are, essentially, inflatable balloons placed inside the penis. They are controlled by a pump in the scrotum.

For men with Peyronie's disease, sometimes the implant is enough to straighten the penis. However, putting in an implant is often combined with additional surgery to straighten the penis. That additional surgery can be either plication or grafting.

As with grafting, penile implant surgery is usually done under general anesthesia or with an epidural. Patients should expect to stay in the hospital overnight.

This surgery involves removing the corpora cavernosa of the penis and replacing them with implants. This affects substantially more tissue than grafting alone, and so recovery is correspondingly longer. After getting a penile implant, it may take several weeks before someone is ready to return to work.

The benefit of penile implant surgery for Peyronie's disease is that it can restore erectile function to someone who is otherwise unable to have penetrative sex.

However, once implants have been put in, they must be used in order to get an erection.

In addition, there is a significant risk of implant failure and a need to replace the device; this is particularly true for younger, more sexually active men. There can also be issues with ongoing curvature and, as with plication, some men experience shortening of the penis after an implant is placed.

A Word From Verywell

Just because a man's penis is curved doesn't mean he needs medical treatment. A slight curve to the penis, particularly one of less than 20 degrees, may have little to no impact on sexual function. It's not something that needs to be addressed with medication or surgery.

The important thing is to talk to a doctor who is experienced in assessing Peyronie's disease. The doctor should be able to talk to you comfortably about your penile health as well as how and if your curvature has changed over time.

Once the extent of your symptoms are known, your doctor should discuss the benefits and risks of choosing ANY treatment, before going into the appropriateness of each possible treatment. It's important to know how each treatment can affect sexual sensation and function, so that you can weight the potential disadvantages as well as the potential benefits. Only then can you make a truly informed choice about both whether you want and need treatment for Peyronie's disease and what treatment might be right for you.

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