Peyronie’s disease background

Peyronie’s disease is a condition of the male reproductive system in which an exaggerated or overabundant scar develops after minor injury to the penis, resulting in varying degrees of curvature and distortion.The abnormal bend and malformation often results in sexual dysfunction and pain.

Since there is no known drug therapy for Peyronie’s disease some men seriously consider undergoing surgical correction as a way to address their problem. Peyronie’s disease surgery criteriaPeyronie’s disease surgery should be considered a realistic option only if a patient fulfills these general four conditions:

1. Severity of condition. This is by far the most important factor. Only if the distortion of Peyronie’s disease places serious limitations on sexual function should it be considered worth the risk of surgery for any potential rewards anticipated.

2. Enough time has passed. Anywhere from 12-18 months from the onset of PD should have lapsed to allow for any potential healing to occur.It is a mistake to enter into surgical intervention before adequate time for self-repair has been given a chance.

3. Not responsive to any treatment.While waiting for the standard one to two year repair phase, a man with PD should use a variety of drug and natural therapies to assist healing.

4. Stability of condition. Only when a case of PD has stabilized, having not improved or worsened for at least six months to a year, will any surgical outcome be thought of as the best opportunity in most cases.

Risks of Peyronie’s disease surgery Martin K. Gelbard, MD, a urologist, is noted to state, "Unfortunately, surgery does not offer a cure for Peyronie’s disease. The scarring in men with deformity severe and persistent enough to warrant an operation represents an irreversible loss of connective tissue elasticity. Though surgical restoration of sexual function can be both effective and reliable, potential candidates need to understand the compromise inherent in this approach."

The use of the term "compromise" in this quote means that some degree of the original Peyronie’s disease pain, problem and limitation will often remain post-surgically and might even be permanent and worse than the original problem. In addition to persistence of old problems even after surgery, new problems sometimes develop in spite of the best technique and skill of the Peyronie’s disease surgeon.

It is a popular axiom that all surgery has risk; none is completely safe or foolproof. Perhaps the single most surprising fact is that no Peyronie’s disease surgery can bring return the penis to its original condition. No one undergoes PD surgery without some reduction of length and circumference. Some surgical techniques shorten the penis more than others, while some can be more effective in reducing penile curvature than others. Each surgery runs the very real risk of not completely straightening the PD bend or curve; some even result in greater curvature after surgery than before it, due to unavoidable additional excess scar formation.

A last caution to consider is that another surgical side-effect that occurs with some frequency is the loss of erection rigidity or firmness.This inability to develop or sustain an erection is the result of permanent alteration of blood flow in the penis caused by surgical complications that create more scar formation.

Peyronie’s disease surgical options

Tissue Grafting – this is the most popular Peyronie’s correction technique in which removal of the Peyronie’s plaque or scar is accomplished by removal (excision). Grafting surgery is best applied when the case involves a severe curve or reduced circumference of the penis. Grafts have been used recently to expand the scar surgically (incision). The results of excision are disappointing with a 20-70% success rate, in which erectile dysfunction develops in 15-70% of cases from damage to the erectile tissue. The results of incision have not yet been studied long enough to develop meaningful statistics, even though there is an early trend of reduction or loss of penile sensation in 10-20% of men.

Nesbit Plication – this technique or one of its many variations involves pinching or gathering (placating, like a pleat) the tissue opposite the plaque on the side of the penis, to create a lateral bending force in an attempt to straighten a curve. Good surgical candidates for Nesbit placation are men with ample penile length, and a simple bend or curve without any associated deformity, such as a bottle-neck, hinge or hour-glass defect. Nesbit plication reduces the length of the penis from one to two inches on average, but usually does not result in erectile dysfunction as does tissue grafting. For this reason Nesbit plication has the highest patient satisfaction rating, with a success rates of 50-60%.It is best used in those cases when the curvature is moderate or less, with no loss of penile girth, and it can also be used to correct congenital curvature.

Prosthesis Implant – in this situation, small bio-inert plastic cylinders that are compatible with local tissue, either solid or inflatable, are surgically placed in the penis to create a state of partial or temporary rigidity.Although these were rather popular 20 years ago, prosthetic penile implants are used less frequently due to the popularity of the many erectile drugs on the market (Viagra, Cialis, etc.). Even so, since many men are either non-responsive or overly responsive in a dangerous way to these drugs, a penile prosthesis remains an option for some.

An overview of Peyronie’s disease surgery

Surgery for Peyronie’s disease is never a minor event; this is a very vascular part of the body, and highly innervated. Because the area of PD is highly sensitive to post-surgical pain, lasting several weeks, it is necessary to anticipate a longer than average recovery with many limitations of physical activity.What is most discouraging to many men is the surprise that some of this post-surgical pain continues for years, and can be more than minor. In today’s insurance driven environment, Peyronie’s disease surgery is an outpatient procedure performed under general anesthesia. Surgery can last up to two and a half hours, and is most commonly complete in less than two hours. Depending on the severity of the tissue contraction and degree of distortion, a plastic surgeon may be required if advanced tissue grafting techniques are necessary.

In spite of the many significant improvements in surgical technique in general, and PD correction in particular, the ideal surgical correction of PD has yet to be developed. T his is most especially true in those cases of severe and complex penile curvature. More urology surgeons have learned it is wise to delay or avoid completely PD surgery. This trend has developed because recent review of several current surgical techniques raises concern for only limited and temporary benefits of PD surgery in relation to the risks involved, and the occurrence of outcomes that sometimes are worse than the original problem. Caution is called for because, unfortunately, surgery cannot fix every aspect of Peyronie’s disease malformation, and it does sometimes make a bad situation worse.

Peyronie’s disease surgery is by far the last option anyone should consider. It just makes good sense to be very conservative, with Peyronie’s disease surgery only as an absolute last resort. Non-surgical and drugless therapy has growing popularity, with continued acceptance within the medical community.

Peyronie’s disease outcomes of surgery

The issue about Peyronie’s disease that makes surgery at times such an interesting option is simply that many men are overwhelmed and frustrated by the bleak outlook for their future with a bent penis. Since there is no known and accepted medical treatment for PD, many men assume that a drastic measure is their best and only option to improve their lot in life with Peyronie’s disease.This is not necessarily true.

First, the eventual outcome of Peyronie’s surgery is not always that good.Since this condition is all about an overabundance of scar tissue to even minor injury to the deep tissue of the shaft of the penis, surgery is a type of traumatic event in which these same deep tissues are cut, stretched, pulled, stitched, injected and pinched during the course of surgery – opening the possibility of further overabundance of scar tissue to develop at the site of surgical intervention.

Second, since a major function of the penis has to do with sexual pleasure, the surgical cutting that is part of any corrective procedure is notorious for cutting those nerves responsible for transmission of those sensations. It is not uncommon for a man to have reduced or lost sexual sensation, and sometimes complete numbness to all sensation, after Peyronie’s disease surgery.

Third, all Peyronie’s disease surgery ends up with a man suffering the loss of highly prized size of his penis as a result of surgical changes that are a part of attempts to reduce curvature. On average, a man will lose from one to two inches of total length and from a half inch to one inch of circumference or girth of his penis.This lost dimension is permanent.

Lastly, the Peyronie’s disease forums are full of commentary and tales from men who report their condition after surgery is no better than before surgery and sometimes worse. These facts need to be kept foremost when someone contemplates PD surgery. It is not an easy or assured fix for a nasty problem. Sometimes having this surgery is a classic example of jumping from the frying pan into the fire.