Plaque incision and graft surgery is a specialized surgical procedure designed to address penile deformity. This reconstructive surgery aims to correct significant curvature and restore the functional anatomy of the penis. It involves precise modifications to the penile tissue to achieve a straighter, more functional outcome.
Peyronie’s Disease as the Underlying Condition
Peyronie’s disease is characterized by fibrous scar tissue (plaque) within the tunica albuginea, the elastic sheath surrounding the penis’s erectile tissue. This plaque can form due to various factors, including repeated microtrauma during sexual activity or sports, genetic predispositions, and certain autoimmune conditions. The scar tissue is non-elastic and does not expand during erection, leading to symptoms such as penile curvature, indentations, shortening, pain during erection, and sometimes erectile dysfunction.
The disease progresses through two phases: an active inflammatory phase and a stable chronic phase. During the active phase, new plaques can form, existing ones may enlarge, and pain is more common. In the stable phase, plaque formation ceases, pain subsides, and the curvature becomes fixed. These deformities can significantly impact sexual function and cause psychological distress.
What Plaque Incision and Graft Surgery Involves
Plaque incision and graft surgery corrects penile curvature and deformities caused by Peyronie’s disease, particularly in cases of severe or complex curvature where penile length preservation is desired. The procedure begins by inducing a full erection, often artificially, to precisely identify the point of maximum curvature and the extent of the plaque. A surgeon then makes incisions (e.g., transverse, “Y”-shaped, or “H”-shaped) into the non-elastic plaque.
These incisions release tension from the constricted plaque, allowing the tunica albuginea to lengthen and the penis to straighten. A defect is created in the tunica albuginea, which is then covered with a graft material to bridge the gap and maintain length and straightness. Graft materials vary, including autologous tissues (from the patient’s body, like saphenous vein or dermis), allografts (from a human donor), or xenografts (from an animal source). The selection of graft material and incision type depends on individual patient factors and surgeon preference, as no single method has consistently shown superiority.
Recovery and Expected Results
Following plaque incision and graft surgery, patients undergo a period of recovery with specific post-operative care. Immediate post-operative care includes pain management, often with prescribed medications, and instructions to avoid activities that could strain the surgical site. Patients are advised to refrain from sexual activity for about six to eight weeks to allow for proper healing of the graft and surrounding tissues.
Expected outcomes include significant improvement in penile curvature, with reported success rates for straightening ranging from 80% to over 90%. While the primary goal is straightening, many men maintain their pre-operative penile length, and some may gain length, depending on the initial deformity. Post-operative rehabilitation may involve penile traction or vacuum erection devices to optimize length outcomes and prevent scar contraction. The aim is to restore satisfactory sexual function and improve overall quality of life.
Risks and Important Considerations
As with any surgical procedure, plaque incision and graft surgery carries potential risks and important considerations. Possible complications include nerve damage, which can lead to altered sensation or numbness in the penis, though this is often temporary. Other risks include infection at the surgical site, graft failure, or the recurrence of curvature if the disease continues to progress or the graft contracts. Erectile dysfunction can also occur or worsen after surgery, with rates varying depending on baseline erectile function.
Patient suitability for this procedure is determined by several factors. Generally, candidates have stable Peyronie’s disease, meaning the curvature has not changed for at least three to six months, and they possess sufficient erectile function to achieve satisfactory erections. The severity of the curvature and the presence of other deformities, such as an hourglass narrowing, also influence candidacy. Consulting with a specialist experienced in Peyronie’s disease is highly recommended to assess individual circumstances and determine if plaque incision and graft surgery is the most appropriate treatment option.