Plication VS Grafting: Which to choose?

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Whyhellothar

50 degree upward Peyronies curve. Developed in my late twenties, and I am now in my mid thirties. Today I had my follow-up six weeks after my fourth cycle of Xiaflex. Turned out I was non-responsive to the treatment. Urologist is now offering surgery as an option if I'd like to continue pursuing correction.

She put two options on the table: Either plication, or excision + temporal grafting.

Plication was presented to me as follows. Positive: Erection functionality is preserved. Negative: Shortening of the penis is more noticeable.

Grafting was presented to me as follows. Positive: Minimizes shortening. Negative: Erection strength decreases an average of 20%, including the potential for rapid loss of an erection "if focus is lost", with a 1-2% chance of impotence. Gray area: She also presented the possibility of some sensory decrease as a negative effect, but I don't really care much about that, because as far as I can tell it just means that I could finally last a little longer than my three minute average during intercourse haha.  :-X

Both options she said would result in a palpable difference, either being sutures on the bottom or a grafted patch on top. Those both sound similar enough to me, so I'm not really weighing the two side effects against each other.

Other risks sounded pretty much shared between the two. Chance for ED, recurrence of the curvature over time, or flat out failure to correct it in the first place during surgery. I already know that I want to choose a surgical option, so if both operations share these risks, then it doesn't sound like I need to factor them into the decision between the two.

I'm not sure which to pick. When it comes to plication, she commented that I have some length to spare in her opinion. (Currently measuring in at about 6 inches when I manually straighten myself — about a 1.5 inch loss since developing Peyronies.) I don't know if she's just saying that to put me at ease when considering a scary option. (Peyronies itself has robbed me of enough length already, so I don't exactly relish the thought of sacrificing more). But if she actually meant it when she said that, then perhaps I'm worrying unnecessarily about that, which actually renders the negative side effect of plication as a moot point!

On the other hand, when it comes to grafting, can't the loss in erection quality (including the more rapid loss if erections when concentration is broken) simply be compensated for with a little blue pill? I don't have experience with lesser erection quality, as I'm still a "relatively young guy" with strong erections according to my uro, so I have difficulty judging exactly how impactful this side effect can be. But if a pill is as simple to live with as it sounds, and it's not even guaranteed that my erection quality would drop enough to need it right away, then that also sounds like a moot side effect.

So... neither option sounds particularly devastating. And again, grafting has what I may be mistakenly interpreting as a benefit in the form of slight sensitivity reduction. So I'm kind of leaning toward grafting...

...but heck, if my logic is off base in any areas here, then I'd like to hear opinions! I've got a year to wait until I'm able to take enough time off of work for a surgery, so I'd like to use this time to hear what others think. What would you choose in my position, and why?

TonySa

Very difficult decision.  Did she mention for a few ED could be a significant side effect.  Also, if going to wait a year are you considering traction to regain lost length and potentially to correct the curve as well.  Even if curve is just improved less length loss as plications would be fewer.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.


Ricardo70


In my humble opinion, although it sounds loudly, its answer as that of many that here we are, it is the implant.
Possibly look like to him an aberration, also I it was looking alike to me, but I believe that the rest is to try to avoid the implant, and in a big number of cases to have than finally to do it.

A lot of luck.


LWillisjr

I had excision and grafting with no issues. First I have heard that there is a loss of erection quality. Dr. Levine told me that my erection quality should be the same before or after. Excision and grafting doesn't directly have anything to do with the mechanics of obtaining and maintaining an erection. The risk is where the plaque is. The most risky being if you have an upward curve. This would indicate the plaque is on the top of your penis and that the excision/grafting would involve manipulating the nerve bundle which runs along the top of the penile shaft from base to glans.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

tiagofil

Well I've read this from author Benjamin A Sherer, Laurence A Levine:
Quote
Peyronies Disease patients with more severe disease (dorsal curvature >60⁰, hourglass deformity,
penile hinging, and/or extensive plaque calcification) are candidates for plaque incision
and grafting (PIG) or partial plaque excision and grafting (PEG) 72,83 . To qualify for a
grafting procedure, it is critical that patients have good preoperative erectile function
(adequate rigidity for penetrative sex with or without use of PDE5-i's) preoperatively 84,85 .
Compared to TAP, grafting procedures have higher rates of postoperative ED, likely due
to disruption of the tunica albuginea and underlying corporal tissue. In the largest
contemporary series of grafting procedures, rates of postoperative ED range from 20-
32% 86-89 .

Don't they check erection quality before... or maybe just mild or nondetected ED gets postoperative ED later? Who knows most of these studies have small followups anyway (12-18 months after).

Still it was misinformation on my part, since postoperative ED seems to be also a possibility in plication technique. The main difference seems to be Plication more shortening, Grafting less sensitivity and more recurrent curvature, maybe because they start with more curvature anyway (>60 degrees) and hinge effect, etc