Reduction corporoplasty is a surgical procedure designed to correct significant curvature or deformity of the penis. This operation straightens the penile shaft by shortening the naturally longer side of the curve, a technique frequently referred to as plication. This method is a form of reconstructive urology intended to restore functional straightness, allowing for satisfactory sexual intercourse. The reduction is achieved by folding or tucking the fibrous sheath surrounding the erectile tissue, known as the tunica albuginea. This successfully corrects the bend without the need for tissue grafts. Corporoplasty describes any surgery that remodels the corpora cavernosa, and “reduction” specifies the shortening mechanism used for correction.
Conditions Treated by Reduction Corporoplasty
Reduction corporoplasty is primarily indicated for two conditions resulting in a pronounced penile bend: Peyronie’s disease and congenital penile curvature. Surgery is considered when the curvature causes functional impairment, such as pain or difficulty with sexual penetration. Patients are evaluated only after the condition has stabilized and non-surgical treatments have failed.
Peyronie’s disease is an acquired condition characterized by the formation of tough, non-elastic scar tissue (plaque) within the tunica albuginea. This plaque prevents the tissue from stretching during an erection, causing the penis to bend toward the scarred area. Surgical candidates must be in the stable, chronic phase, meaning there has been no change in the degree of curvature or associated pain for at least six months.
Surgical intervention is generally warranted for a stable bend greater than 30 degrees, as this level often impedes coitus. Congenital penile curvature, or chordee, is present from birth and is caused by developmental abnormalities, such as a disproportionately short urethra. In both cases, the goal is to make the penis functionally straight, often defined as having a residual curvature of 20 degrees or less.
Surgical Technique of the Plication Procedure
The plication procedure is a tunical shortening operation that focuses on cinching the tunica albuginea on the convex side to straighten the penis. The surgery begins with an incision, often circumferential near the head of the penis, allowing the outer skin to be pulled back. This “degloving” provides clear access to the tunica albuginea, the fibrous layer surrounding the erectile tissue.
A crucial initial step is inducing an artificial erection, typically by injecting saline or a vasoactive medication into the erectile chambers. This allows the surgeon to precisely visualize and measure the location and degree of the curvature in its erect state. The surgeon then identifies the convex side of the bend, which is the longer tissue that needs to be shortened.
To achieve the reduction, a series of non-absorbable sutures are strategically placed into the tunica albuginea on the convex side. These sutures tuck or fold the tissue, creating an artificial pleat that counteracts the bend caused by scar tissue on the opposite, concave side. This is a plication-only method, such as the Essed-Schroeder or 16-dot plication, as it does not require cutting or removing large sections of the tunica.
Once the sutures are tightened, a second artificial erection is induced to confirm adequate straightening. The sutures are placed with buried knots to minimize the chance of them being felt later. The procedure aims to correct the bend while preserving the neurovascular bundle, which is essential for sensation and function.
Pre-Surgical Assessment and Recovery Expectations
Pre-Surgical Assessment
Pre-surgical assessment focuses on confirming the stability of the condition and the patient’s suitability for surgery. The evaluation includes a comprehensive physical examination, where the urologist measures the degree of curvature and assesses penile dimensions. An intracavernosal injection test is often performed in the office to induce a full erection, allowing for accurate measurement of the bend and documentation of any associated deformities.
A penile ultrasound may be used to visualize the tunica albuginea, confirm the presence and location of scar tissue, and check blood flow to ensure adequate erectile function. The patient must have stable disease, meaning the curvature has not progressed for several months. They must also have sufficient erectile length remaining to accommodate the length reduction that occurs with plication. General pre-operative health assessments, including blood work and cardiac evaluation, are completed to minimize surgical and anesthetic risks.
Recovery Expectations
Following the procedure, patients can expect a recovery period requiring careful adherence to post-operative instructions. Immediate care involves pain management and meticulous wound care to prevent infection at the incision site. The primary restriction is the complete avoidance of sexual activity, including intercourse and masturbation, for four to eight weeks to allow the sutures and tunica albuginea to heal securely.
A known trade-off of the plication technique is a loss of erect penile length, as the procedure shortens the longer side to straighten the shaft. Patients are counseled that a length reduction of up to one to two centimeters is common. Potential complications include the risk of a residual curvature if the initial correction was incomplete, or the possibility of feeling the non-absorbable knots beneath the skin. Patients should monitor for any palpable firm areas or changes in sensation that could indicate nerve irritation.