I am concerned

[Norm]

I am really concerned about this. I have been on this forum for a while and you can see below my treatment approach. What concerns me is, I have been watching videos of Peyronies Disease surgeries on YouTube. Very interesting but painful to watch. One in particular was a doctor in Chicago working on a fellow with left curvature and a hinge effect. It looked exactly like my problem. Watching that video, I could see what my problem is. It just looked like a blowout in the guys penis. There was a big dent of damaged tissue. The doc removed the injured tissue and grafted in a synthetic piece.. Everything ended happily. I have contended that surgery is not for me. But after seeing that video, I have to ask if all the Pentox, supplements, and VED therapy in the world is gonna cure what I've got! It makes me think I am wasting my time. I really don't want that surgery. It looks horrific! But is my current therapy approach ever going to regenerate new tissue? Or am I one of the ones who will have to live with it or have it corrected? Neither sounds good to me.  

[james1947]

Norm

I really understand you because I feel sometimes the same. Many on the forum had success with oral treatments and VED, many not so.
My progress is very slow and I am thinking sometimes like you.
It is also very difficult to see those videos for me. I will go under the knife just if the modelling of the Peyronies plaques will be associated by an implant because of my ED.
Regarding excision, from what I understand the incision have less chance to make ED.

James  

[Norm]

I just don't see how drugs, supplements, and physical therapy are going to revive damaged tissue. It's like a broken bone in that sense. I was all in favor of my approach until I saw that video demonstrating just what causes the "hinge". I would like to think this could be repaired by therapy, but that blew my hopes. Has anyone with hinge had success with VED and chemicals?  

[james1947]

In a combined mechanical/chemical treatment is very difficult to point out what helped, but my hinge get less pronounced during the last year.

James

[Ben]

Norm After reading your previous post I think you could really benefit from surgery. As James says it's a bit risky to choose grafting surgery as it can bring ED as side effect. Standard procedure is much safer because of it.

Take your time to make up your mind if you think that surgery is a reasonnable option for you. What I can say to you about traction and pentox is that I started with a lot of pain thinking of my penis and ended much more comfortable. It was not a 100 % but living with it was easier.

Surgery may not be the good choice if you have not tried the non-invasive technique first.  

[Norm]

Thanks Ben,
I have been on the VED and supplements for a few months. The VED makes me feel a little fuller. That I use curved-cylinder therapy makes my flaccid hang look straighter. But in all, I have seen no change when erect. The surgeries just look so midieval, I mean, skinning the penis to work on it? How godawful is that? I haven't discussed this with my wife, but I plan to. Next time we have sex, afterwards, I will show her the video of the surgery. She can help me decide if we want to go through that. I don't have a problem with continuing non-invasive therapy if I can just get some assurance that it can help with the "hinge". But after what I saw on the video, I just don't see it happening.  

[Hawk]

I mean, skinning the penis to work on it? How godawful is that? I haven't discussed this with my wife, but I plan to.

Norm, now I know why you don't want surgery.  You think they are skinning the penis.  No Wonder!

In fact what they are actually doing is called "degloving the penis".  Now that you fully understand the difference I am sure you will want a spinal so you can watch and chat with the doctor during the procedure.  

Ya gotta love these euphemistic terms.  They probably actually helped reduce the trauma before Youtube came along to show the procedures.  And I am with you.  I can watch any procedure on video or in person but this penile surgery (including a prosthesis) is brutal on the psyche. The only other one I ever saw that was tough to watch is surgery cutting into the eyeball.

[Norm]

To-may-to, to-mah-to! They can call it any euphemistic name that sounds gentler. But they are cutting circumferentially below the glans and shucking the skin back! In my eyes that is skinning the penis. I know that it is less traumatic than it looks, but geez. It's our penis we're talking about! I would go through it if it is the only way. But what I am looking for is some assurance that there is a non invasive way to repair that damaged tissue where the hinge is. So far, I have not seen anyone attest to that.  

[BrooksBro]

Oral pharmaceuticals and physical therapy are the first treatment choice, because "some" men respond, and these are less traumatic, have less risk, and cost less.  After a trial period of these methods, "some" men respond to Verapamil injections into the plaque tissue.  This is more expensive and has higher risk than does oral medications.  If these fail, there is always surgery, and there are several types, depending on the condition.  The least risk is plication (shortening) of the convex curved side; this can be by permanent sutures, or by cutting the tunica albugenia and suturing it back together.  Neither of these techniques require full degloving.

At the most extreme (highest risk of complication and failure) is direct plaque excision and grafting.  It generally requires full degloving.

Both plication and excision/grafting presume no to little erectile dysfunction.

Where ED is profound, an implant is the best solution.  It does not require degloving either.

[LWillisjr]

Just so everyone understands....  When they make the incision, the skin covering the penis simply slides back. It isn't "peeled" back and isn't like you are field dressing an animal. The skin covering the penis is not connected to the Tunica in any way other than where it connects to the glans just below the corona. This is where the term de-gloving comes from. It's no different than making an incision around your finger while wearing a glove and then sliding the material down over your finger.

[james1947]

lwillisjr

After your explanation regarding "de-gloving" it sounds much less scary

James

[LWillisjr]

Thanks James.

I'm speaking from experience as I have had this done to me. I know surgery is scary, but I think it helps to be absolutely clear what the various procedures are for those who are considering this.

Les

[Norm]

Now that is an explanation that I can buy into. I did not know the skin was not attached. Thank you for that insight.  

[Norm]

With a little help from a friend on this forum, I have found a doctor in Dallas who performs plication surgery without de-gloving. He makes a 2 cm incision at the base of the penis and makes his sutures from there. There is minimal trauma and minimal side effect. That makes me seriously consider making a consultation appointment. If I do, I will keep you guys advised of what is going on. Those de-gloving videos on YouTube totally scared me away. This newfound information gives me hope.  

[MattFoley]

Norm, that sounds good. I too am completely terrified of being "de-gloved". Although I'm quite a bit away from thinking about surgery, it would be good to know that there is an alternative to that process. Please keep us updated. Thank you.

[Norm]

Somewhere on this forum I saw some words of wisdom. They went something along this line; "surgery is the last resort. But that does not mean that it is NOT a resort". If you think about it, surgery is the last resort for any ailment. They only operate when all other non-invasive approaches have failed to achieve a favorable response. None of us wants surgery of any type. We, here on the forum, don't want our penises cut on. But if we have tried everything and have not gotten satisfactory results, then we know what is next. To you guys who have had surgery I say congrats! You guys are courageous!  

[MattFoley]

Norm, well said.

Even though I have a 75-80% curve, it doesn't bother me as much as the venous leakage. Even with high doses of Cialis and/or Viagra, I'm not able to achieve the pre-Peyronie's firmness. If the surgical option could promise me a 90% return to that firmness then the risks might be acceptable to me some way down the road. I really have to give my current treatment a chance before going that route.

[james1947]

Quote from Norm:

They only operate when all other non-invasive approaches have failed

You mean doctors, no? Unfortunately I had cases that it was not the approach of the doctors that treated me.
Maybe I was not on this forum if this was they approach

James

[LWillisjr]

But if we have tried everything and have not gotten satisfactory results, then we know what is next. To you guys who have had surgery I say congrats! You guys are courageous!

I was having second thoughts up to and including the morning of the surgery. Asking myself "Do I REALLY wnat to do this?

But now I'm glad I did.

[LWillisjr]

Even though I have a 75-80% curve, it doesn't bother me as much as the venous leakage.

Matt,
Do you mean you have a 75-80 DEGEREE curve, or that your erections are only about 75-80% as firm as they used to be. I'm confused about you using a percentage in reference to a curve.

[MattFoley]

Hi lwillisjr,

I have a 75-80% degree bend upward. My penis is a little less than like an "L".

[LWillisjr]

Matt,
If you have an 80 degree bend, then I assume that intercourse is next to impossible. I'll buy into the arguement that low "T" could have led to this, but increasing your "T" alone is not going to improve an 80 degree curve.

I'm guessing you will need a more agressive therpay to resolve your Peyronies Disease curve.

[MattFoley]

lwillisjr,

Sex is definitely not easy but I can bend my penis into place and after I achieve penetration, as long as I don't pull all the way out, I can get the job done. For me, the worst part is not having a 100% pre-Peyronie's firmness. As I mentioned, I haven't lost any measurable girth or length and no obvious hourglass formation.

No question that testosterone alone will not fix the problem but it can only help. I'm looking to try everything short of surgery at this point.

If you have any advice, I would appreciate your thoughts. Thank you.

[Norm]

My prob is much the same. I can work to get it in, but I better stay in or I have to fight it again. That takes a little of the fun away. The Cialis/Viagra doesn't help with rigidity?

[BrooksBro]

Getting and keeping an erection are two different things, achieved by two different mechanisms.  Viagra and the other PDE5 inhibitors allow adequate arterial blood flow into the erectile tissue to produce the initial erection.  As the tissue swells, it needs to close off the veins that drain the tissue in order to hold the blood in place.  The plaque (scar tissue in the tunica abugenia) is inelastic, which can limit the ability of the veins to be compressed.  This is sometimes called "venous leakage."

A low tension constricting band, applied with a VED, may help to maintain an erection.

I had a similar problem - 85 degree upward curve.  A strong erection (and constricting band) was adequate for penetration, but I just could not get it in.  With a weaker erection (no constricting band), I could not stay in.  Plication was my solution to the excessive curve.  I still have to use a constricting band for the venous leakage problem.  Meaning, the plaque is still there, and it still will not allow the tissue to expand and close off the veins sufficiently.

[MattFoley]

Yep, that's the problem right there. Cialis and Viagra get me erect and provide significant help but not the kind of firmness that once existed. Even with a band around the testicles and/or around the base of the penis, for some reason it's still not working right for me.

[LWillisjr]

I would think that if your erection was "rock hard" then you would not be able to bend it and overcome the 80 degree curve. Sounds like you are battling a combination of issues.

[Noway]

norm

I look at pictures of peyronies surgery on the internet and on youtube or whatever i cringe and have to look away that one day i might need to do one of these i can just imagine.