Peyronie’s Disease (PD) is a condition characterized by the formation of fibrous scar tissue, known as plaque, within the penis. This plaque can cause the penis to bend, curve, or lose length, often leading to pain during erections and making sexual intercourse difficult or impossible. While some cases of PD may improve with non-surgical methods, surgical intervention is considered when conservative treatments are insufficient and the condition has stabilized, typically after 9 to 12 months of stable condition.
Understanding Surgical Approaches for Peyronie’s Disease
Surgical options for Peyronie’s Disease aim to correct the penile deformity and restore function. Plication procedures involve shortening the longer side of the penis to match the side with the plaque, thereby straightening the penis. This is achieved by placing sutures or removing small pieces of tissue on the unaffected side, effectively cinching the tissue to counteract the bend. This approach is used for less severe curvatures (under 60-70 degrees) and in patients with good erectile function.
Another surgical technique is incision and grafting, which addresses the scar tissue directly. This procedure involves making an incision into or partially excising the plaque at the point of maximum curvature. A graft, which can be biological (from the patient’s body) or synthetic, is then sutured into the created defect. This method aims to lengthen the concave side of the penis, helping to straighten it and potentially restore lost length. Incision and grafting is used for more severe curvatures (over 60 degrees), significant penile shortening, or an “hourglass” deformity.
Penile implants are a different surgical approach, primarily used when Peyronie’s Disease is accompanied by severe erectile dysfunction (ED) that has not responded to other treatments. These devices are surgically placed inside the penis to allow a man to achieve an erection. The implant itself can help straighten the penis, and in some cases, additional manual modeling or straightening maneuvers may be performed during the same surgery to address the curvature.
Immediate Post-Operative Recovery
Following Peyronie’s disease surgery, patients can expect a period of initial recovery lasting several weeks to a couple of months. Pain management is an important aspect of this period, and discomfort at the surgical site is common. Over-the-counter pain relievers like paracetamol and ibuprofen are usually sufficient, though stronger medication may be prescribed for a few days after the procedure.
Wound care focuses on preventing infection and promoting healing. A clear dressing may be applied to the penis for the first two to three days to limit swelling. Patients receive instructions on gentle removal. Daily showering is encouraged after dressing removal, with gentle washing of the incision area. Avoid scrubbing or applying ointments like antibiotics or hydrogen peroxide.
Activity restrictions protect the healing penis. Patients should remain home and limit significant activity for the first two weeks, avoiding strenuous physical activities, running, or cycling. Sexual activity, including intercourse and masturbation, should be avoided for six to eight weeks to allow complete healing. Swelling and bruising of the penis and scrotum are common in the initial days and weeks after surgery, gradually improving.
Follow-up appointments with the surgeon monitor healing and assess surgical outcome. The first follow-up occurs within 24 hours for a wound check, with subsequent visits within one to two weeks. These appointments ensure recovery progresses as expected and allow the surgeon to provide further guidance.
Long-Term Outcomes and Potential Complications
Long-term outcomes after Peyronie’s disease surgery include significant improvement in penile curvature and reduced or eliminated pain during erections, allowing a return to satisfactory sexual function. With plication procedures, success rates for penile straightening range from 79% to 100%, with patient satisfaction reported between 67% and 100%. For incision and grafting techniques, successful outcomes often result in a functionally straight penis, with patient satisfaction reported even after ten years. When penile implants are used, particularly for men with co-existing erectile dysfunction, high satisfaction rates of 86-90% are reported, as the implant can address both the curvature and erectile function.
Despite these positive outcomes, long-term challenges and complications can arise. Recurrence of curvature can occur, with reported rates between 10% and 33%, and new plaques may form in other areas of the penis. Persistent curvature can occur if the initial surgery does not achieve complete straightening, with some experts defining functional straightness as 20 degrees or less of residual curvature. Penile shortening is a common concern, particularly with plication procedures, where length loss can be up to 3 cm. While grafting aims to preserve or even increase length, some patients may still experience perceived length loss.
Erectile dysfunction (ED) can be new or worsened after surgery, especially with incision and grafting procedures, with a risk of worsened erectile function around 20%. Nerve damage or sensory changes, such as numbness or altered sensation in the penis, are also potential complications; approximately 20% of patients report such issues up to two years post-surgery. Internal scarring, beyond the original Peyronie’s plaque, can also occur and may affect function or appearance.
Infection, while less common, is a serious complication of any surgery. Penile implants carry specific risks such as mechanical failure (e.g., fluid leakage, cylinder or reservoir dysfunction) and erosion, where the device moves from its proper position. While rare, if an infection occurs with an implant, it often requires device removal. Patients should seek immediate medical attention for severe pain, fever, signs of infection (e.g., increased swelling, creamy drainage, increased tenderness at the incision site), or significant new or worsening penile curvature post-surgery.