Peyronie’s disease is a condition characterized by the formation of fibrous scar tissue, known as plaque, within the tunica albuginea, the sheath of tissue surrounding the corpora cavernosa of the penis. This plaque can cause penile curvature, indentation, pain, and sometimes erectile dysfunction, making sexual activity difficult or impossible. While non-surgical treatments are often explored first, surgery becomes a consideration when the condition stabilizes and symptoms significantly impair function or quality of life.
Understanding Surgical Candidacy and Options
Patients are considered candidates for Peyronie’s disease surgery once their condition has been stable for at least 3 to 6 months, meaning the curvature and pain have stopped progressing. Surgical intervention is reserved for individuals with a severe curvature, usually greater than 30 to 45 degrees, that prevents satisfactory intercourse or causes significant discomfort. The presence of erectile dysfunction that does not respond to oral medications or other less invasive treatments also guides the decision toward surgery.
Penile plication involves shortening the longer, unaffected side of the penis to match the shorter, scarred side. Procedures like the Nesbit procedure or various modified plication techniques achieve this by excising or suturing small ellipses of tissue on the convex side of the curvature. Plication is recommended for men with good erectile function and curvatures without significant hourglass deformities or severe penile shortening.
Grafting procedures involve incising or excising the plaque to release the curvature, then covering the defect with a graft material. Common graft sources include autologous tissues like saphenous vein from the leg or buccal mucosa from the cheek, or sometimes synthetic materials. Grafting is considered for more severe curvatures, complex deformities, or when there is significant penile shortening, aiming to restore length lost due to the disease.
For patients experiencing both Peyronie’s disease and severe erectile dysfunction that has not responded to other therapies, the insertion of a penile implant is a preferred surgical solution. This procedure involves placing inflatable or malleable rods into the penis, which can simultaneously straighten the curvature while providing sufficient rigidity for intercourse.
Preparing for Surgery
Once surgery is decided upon, several preparatory steps are taken to optimize outcomes. Pre-operative assessments include a thorough physical examination, detailed medical history review, and specific imaging studies. A penile ultrasound or magnetic resonance imaging (MRI) may be performed to precisely map the plaque location, size, and extent of calcification, which guides the surgical plan.
Patients are advised to make certain lifestyle adjustments before surgery. These include discontinuing medications that affect blood clotting, such as aspirin or non-steroidal anti-inflammatory drugs, several days or weeks prior to the procedure. For individuals who smoke, cessation is encouraged, as smoking can impair wound healing and increase the risk of complications. Managing any underlying health conditions, such as diabetes or hypertension, is also important for surgery and recovery.
On the day of surgery, patients will follow specific admission procedures, involving checking into the surgical facility and reviewing consent forms. General anesthesia will be administered for comfort and pain control. The surgical team will provide detailed instructions regarding fasting and other pre-operative protocols.
Post-Operative Recovery
The immediate post-operative period involves managing discomfort and ensuring proper healing. Patients may experience some pain, swelling, and bruising, which can be managed with prescribed pain medication. An initial hospital stay may be brief, overnight or as an outpatient procedure, depending on the complexity of the surgery.
Wound care instructions involve keeping the surgical site clean and dry, with specific guidance on dressing changes. Swelling and bruising are normal and gradually subside over several weeks. Activity restrictions are important during this phase, with patients advised to avoid strenuous exercise, heavy lifting, and sexual activity for approximately 4 to 8 weeks, allowing tissues to heal properly.
Follow-up appointments with the surgeon are scheduled to monitor healing progress and address any concerns. These visits are important for assessing the early results of the surgery and ensuring there are no complications. Depending on the procedure, some surgeons may recommend post-operative rehabilitation measures, such as gentle penile stretching exercises or the use of a vacuum erection device, to help prevent scar tissue formation and optimize length outcomes.
Long-Term Results and Post-Surgical Considerations
The long-term results of Peyronie’s disease surgery involve a significant reduction in penile curvature, allowing for satisfactory intercourse. The degree of correction varies based on the initial severity of the curvature and the surgical technique employed, but many patients achieve a nearly straight penis. While some penile shortening can occur, particularly with plication procedures, grafting aims to preserve or even restore some length.
Changes in erectile function post-surgery can occur; some men may experience improved erections due to curvature correction, while others may notice a temporary or permanent decrease in rigidity. Sensory changes, such as temporary numbness or altered sensation in the penis, are also common, particularly after grafting procedures, but these improve over several months. Persistent pain after surgery is infrequent.
Recurrence of curvature after successful surgery is rare, especially once the initial healing period is complete. However, patients should maintain realistic expectations regarding the outcome, as a perfectly straight penis is not always achievable, and some degree of residual curvature may remain. Open communication with the surgeon regarding any ongoing concerns or unexpected changes is encouraged for long-term follow-up and management.