Peyronie’s disease is an acquired condition characterized by the development of fibrous scar tissue, known as a plaque, on the tough, elastic layer of tissue inside the penis called the tunica albuginea. This plaque is not the same as the substance that builds up in arteries. Its presence can lead to a bend or curvature in the erect penis, which can cause pain and may interfere with sexual activity. The condition is understood to result from minor penile trauma, often occurring during intercourse, which triggers an atypical wound healing response.
Determining Candidacy for Surgery
The decision to have surgery for Peyronie’s disease depends on the stability of the condition and its impact on sexual function. The disease has two phases: an initial acute phase and a later chronic, or stable, phase. The acute phase involves active inflammation, penile pain during erections, and a possibly changing curvature. Surgical intervention is not recommended during this active period.
Surgery is reserved for the chronic phase, which begins once the plaque and curvature have stabilized for at least three to six months. At this stage, any pain has usually resolved. A healthcare provider will confirm the disease is stable before considering an operation. Surgery becomes an option when the bend is significant enough to make sexual intercourse difficult or impossible, and after less invasive treatments like medications or injections have failed to provide sufficient improvement.
Types of Surgical Procedures
There are three main surgical procedures to correct the curvature caused by Peyronie’s disease. The first, penile plication, involves placing sutures on the side of the penis opposite the plaque. This shortens the longer, unaffected side to match the length of the scarred side, which straightens the penis. This procedure is best for men with less severe curvatures who have ample penile length, as a primary trade-off is a loss of penile length.
For more severe deformities, such as a sharp angle or an indentation, plaque incision or excision and grafting is used. The surgeon makes cuts into the plaque to release tension and allow the penis to straighten, sometimes removing the plaque itself. The resulting gap is filled with a graft material from the patient’s body or other sources. This method avoids penile shortening but carries a higher risk of developing or worsening erectile dysfunction.
The third option is the implantation of a penile prosthesis. This procedure is for men who have both Peyronie’s disease and significant erectile dysfunction. Inflatable or malleable rods are placed inside the erection chambers of the penis. The implant provides the rigidity for an erection and mechanically straightens the penis, correcting the curvature. This is a more invasive procedure with the risks associated with prosthetic devices, such as infection or malfunction.
Potential Risks and Complications
Surgical correction of Peyronie’s disease has potential risks that patients must consider. Penile shortening is an expected consequence of plication procedures but can also occur to a lesser degree with grafting. The extent of length loss varies depending on the initial severity of the curve and the specific technique used.
Changes in penile sensation, such as decreased sensitivity or numbness in the head of the penis, are another possible complication. This is more common with plaque incision and grafting procedures, which involve more dissection around nerve bundles. While sensation often returns over time, the changes can sometimes be prolonged or permanent.
A significant concern is the potential for new or worsened erectile dysfunction (ED). The risk is notably higher with plaque incision and grafting, as the dissection required can impact the vascular structures responsible for erections. There is also the possibility that the penile curvature may not be fully corrected or could recur. General surgical risks include infection, bleeding, or adverse reactions to anesthesia.
The Recovery and Healing Process
Immediately after surgery, patients can expect some pain, bruising, and swelling, which is managed with pain medication and ice packs. The penis will be bandaged, and patients receive specific instructions on wound care. Most individuals can return to non-strenuous work and light daily activities within a few days to a week.
Post-operative rehabilitation is part of the recovery, particularly after grafting procedures. To prevent new scar tissue and ensure the penis heals straight, patients may be instructed to perform manual penile modeling or stretching exercises. The use of a vacuum erection device may also be recommended to stretch the tissues and promote blood flow, which aids healing.
Surgeons advise patients to wait approximately four to six weeks before engaging in any sexual activity to allow incisions to heal completely. The final results of the surgery, in terms of straightness and function, may not be fully apparent for several months. Following the surgeon’s post-operative instructions is directly linked to the success of the procedure.