Peyronie’s Disease & Penile Curvature Treatment

Correction of the abnormal bend in your penis during erection. Peyronie's disease was first known as induratio penis plastica. It was subsequently named after Francois Gigot de la Peyronie because he was the first to describe and offer treatment for it in a paper published in 1743. Peyronie's disease is where plaques (segments of flat scar tissue) form under the skin of the penis. Peyronie disease is currently recognized as a wound-healing disorder of inside the penis, in the thick elastic membrane called the tunica albuginea tunica albuginea.
The resulting fibrous scar tissue or plaque is inelastic and therefore results in penile deformity including curved painful erection, indentation, hinge effect, and penile shortening and is frequently accompanied by erectile dysfunction. Some men with this condition don’t have a curve, but might have an area of indentation or “hourglass” appearance.
We know that the prevalence of Peyronie's disease is between 3% and 20%, and in men with diabetes mellitus, erectile dysfunction, previous history of radical prostatectomy, aging and/or collagen disorders the prevalence may be even higher.

The most frequent presenting symptoms of patients with Peyronie's disease include hard lumps on one or more sides of the penis, pain during sexual intercourse or during an erection, a curve in the penis with or without an erection, changes in the shape of the penis, such as narrowing or penile shortening, performance anxiety due to penis appearance, and erectile dysfunction. In many cases, the pain decreases over time, although the curve in the penis may remain. Problems with intercourse or erectile dysfunction can occur during either acute and chronic phase.

Who Is a Good Candidate for Penile Implants?
And Who Is Not?

You are good candidates;

  • If Peyronie’s disease makes it hard to have sex
  • If erections or intercourse, or both, are painful
  • If you can't get an sufficient erection for sexual activity
  • If you have severe scarring inside the penis with erectile dysfunction, curved and painful erections (Peyronie’s disease)
  • If you have penile deformity and/or atrophy
  • If you have severe worry as a result of Peyronie's disease
  • If your symptoms have not improved
  • If you are in chronic phase
  • If you have congenital curvature (penile curvature)

You are NOT good candidates;

    • If you are in acute phase of Peyronie's disease. In acute phase, your plaque and penis curving is not stable and acute phase is around 5 to 7 months
    • If you have mild curvature and the curvature is not prevents sexual intercourse


Smoking and alcohol consumption are not important factor in patient selection.

Risk and Side Effect

Risks and side effects of surgical treatment are:

  • Pain
  • Irritation
  • Uncontrolled bleeding following surgery; this condition may necessitate extra surgery. (<%0.1)
  • Infection. As with any surgery, infection is possible and infection rates are <%1.
  • Formation of scar tissue
  • Shortening surgery can make the penis shorter
  • A knot or lump that can be felt under the skin in shortening (plication, Nesbit) surgery
  • Infection. As with any surgery, infection is possible and infection rates are <%1.
  • Formation of scar tissue
  • Shortening surgery can make the penis shorter
  • Infection. As with any surgery, infection is possible and infection rates are <%1.
  • Sensation changes
  • Risk of worsened erections, especially in graft surgery
  • If penile prosthesis surgery is performed, risks of penile implant surgery may develop. Click to see them.
 
 
 
 
 
 

Before The Procedure

You temporarily stop taking aspirin and other anticoagulant drugs, which can increase your risk of bleeding. Peyronie's disease and penile curvature surgery is done at hospital. Don't eat or drink anything after midnight before your surgery. Your anesthesia doctor might give you medication to make you unconscious during the surgery (general anesthesia) or medication that blocks pain in the lower part of your body (spinal anesthesia).

Your doctor will give you IV antibiotics to help prevent surgical and hospital acquired infection. The surgical incision site will also be shaved in operation room and washed with an alcohol-based antibiotic solution to decrease the risk of infection.

Types of Surgery

There are three main types of Peyronie's disease and penile curvature surgery.
  • Shortening the unaffected side
  • Lengthening the scar tissue side
  • Penile implant (prosthesis)

During Surgery

A tube (catheter) might be inserted into your bladder via your penis to collect urine in the operation room. Your doctor will make a circumcision incision. Next, your doctor will stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of two hollow chambers called the corpora cavernosa. Your doctor will will make an artificial erection to evaluate curvature.

Surgery to Shortening the Unaffected Side of the Penis (Opposite the Plaque/Curve)

This type of surgery can be done either by cutting out small pieces of tissue on the outside of the curve and sewing it closed or by folding the tissue and pulling it together with surgical thread. This type of surgery is known as plication, Nesbit procedure or penile shortening surgery. The surgery is most often safe, easy for the surgeon to do and has a low risk of problems (such as bleeding or making erectile dysfunction worse). A drawback is that this type of surgery can make the penis shorter.
  • This surgery is better for men with mild or no erectile dysfunction, mild-to-moderate penile curving and a long penis.

Surgery to Lengthening the Scar Tissue Side of the Penis

This type of surgery is used when the penile curve is severe, the plaque becomes calcified or the shaft has become very narrow. The surgeon cuts the plaque to ease tension and may remove some of the plaque. The space that is left is then filled with a graft. In most cases, this surgery will not make the penis much shorter. But it is harder for the surgeon to do and there is a risk it could make erectile dysfunction worse.
  • This surgery is often only recommended for cases of severe deformity in men who are able to get erections hard enough for sex.

Penile Implant

An inflatable pump or malleable silicone rods placed inside the penis are good options for men with Peyronie's disease and moderate-to-severe erectile dysfunction. In most cases, this will straighten the penis and allow it to get stiff enough for sex. If the device doesn't straighten the penis enough, your doctor may straighten it more by modeling the plaque against the stiff prosthesis or by cutting the plaque and using a graft to cover the opening.
  • This surgery is often recommended for cases of Peyronie's disease and moderate-to-severe erectile dysfunction.
Once the all steps of surgery are finished, your doctor will sew the incisions closed. Peyronie's disease surgery usually takes 45 minutes to an hour.

After Surgery

After Peyronie's disease surgery, you will likely need to take medications to ease pain. Mild pain might persist for 1-2 weeks. You might be given an antibiotic to be taken by mouth for a week to lower the risk of infection. Most men can resume strenuous physical activity about 4 to 6 weeks after surgery. You should not have sex for at least 6 weeks after surgery.

Results

Surgical treatment for Peyronie’s disease can improve erectile function and intimate satisfaction for you and your partner. Treatment can also reduce discomfort and frustration during sexual intercourse. Reducing the appearance of abnormalities can also boost self-confidence in all areas of your life.

Recovery Timeline

Recovery will vary for each man based on his immune system, type of surgery, and other factors. In general, you should expect to be out of activity for one to two weeks following your Peyronie's disease surgery. Within the first 5 days after surgery, the incision should heal. During the first week, swelling and discomfort will also subside considerably.

Everyone is unique, and healing times vary. However, the average recovery time is 6 weeks before you may start any sexual activity. During this period, your surgeon will evaluate what you may and cannot do. For the best results, it is important to follow all instructions from your health care providers.
 
 
 
 
 
 
 
 

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1How long do I need to stay in the hospital for?
After the operation you would need to stay in hospital for 3-4 hours. During this time you will be attended by our nurse, provided with food, be reviewed by your surgeon and then you will be ready to go home. You will be able to walk and function normally, usually with very little pain or discomfort.
2Which surgical technique is the most successful to treat Peyronie’s?
In general, we do not believe there are best techniques. All surgical techniques have advantages and disadvantages depending on an individual patient’s profile and the most important thing is that the appropriate technique is selected for the appropriate patient.
3I am travelling from abroad – how long do I need to stay for follow up after my surgery?
You will have a follow up in office consultation the next day after your operation with your surgeon to check that everything is fine. After this, most patients can travel although we recommend that you stay for a further 1-2 days so that you can have further follow-ups over the next few days with your surgeon if required.
4How long after the surgery can I resume sexual activity?
Sexual activities can resume 4-6 weeks after your treatment unless your surgeon advised otherwise.
5Can I prevent Peyronie's disease from developing?
Peyronie’s disease can develop from penis injuries that often result from vigorous or frequent intercourse that can lead to accidental bending or “wear and tear” injuries. Researchers do not know how to prevent Peyronie’s disease. At this time, diet and nutrition have not been found to play a role in preventing Peyronie’s disease. However, practice safe sex and avoid injuries by using lubricant, taking any prescribed medications to maintain an erection, and avoiding positions that could bend or twist the penis.
6Can Peyronie’s disease be cured?
The symptoms of Peyronie’s disease can be improved using the various available treatments. Unfortunately, no treatment can claim to cure Peyronie’s disease 100% of the time.
7Does Peyronie's Disease Turn into Cancer?
Cells taken from Peyronie's plaques may act like cancer cells in some ways, such as not dying normally and forming tumors. But there has never been a case of Peyronie's disease that has turned into a cancer in a human.
8I am only 20. Could I have Peyronie's disease?
Yes if you are displaying the symptoms you could. Although Peyronie’s disease is more common in older men it does happen to younger men too
9How do I know if I have Peyronie''s Disease and not congenital penile curvature?
Congenital penile curvature means that you are born with the condition while Peyronie's disease is acquired as the result of a penis injury. However, is is better to consult a doctor for a formal diagnosis.
10Does Peyronie’s disease cause erectile dysfunction?
Peyronie’s disease can cause erectile dysfunction by interfering with the normal blood trapping valves that are important for getting or maintaining an erection.
11Is Peyronie’s disease contagious?
No. Peyronie’s is not contagious or caused by any other disease.
12Can Peyronie's disease lead to premature ejaculation?
It is possible due to the anxiety that the disease creates in the patient, the pain during erections or deformity of the penis. In many cases, correcting the curvature can solve and/or alleviate this problem. If premature ejaculation is not associated with Peyronie's disease, treatment is available. A face-to-face evaluation with a urologist is recommended.
13If I get penetration, can my partner experience any discomfort?
Probably yes, when the penile curvature is accentuated. Penetration can be facilitated with the help of the hand, but the partner may experience discomfort during intercourse, so dialogue and complicity are very important so that the partner can report if it is causing discomfort and/or pain. In many cases, the partner may be embarrassed and avoid talking so as not to frustrate the patient.

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