Plaque size and surgery

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MeMo

Hey all;
I visited my uro to investigate the possibility of surgery, he said me the most important factor which indicates how a peyronies case is extended is the plaque numbers and their sizes.
in my case i have 2 ring shape 7,5 Cm in length, 3mm in wide and 4mm in thickness unclassified plaques. My uro believes they are to big for surgery especially the thickness is my main obstacle.  
it would be appreciated if people who did surgery (especially excision grafting) already let me know how was their plaque size and situation.
regards.  

Knight

Very interesting. If this holds up to be true than I wonder why they all seem to insist on having us wait forever before giving in to the option of surgery. I'm no doctor but it doesn't take a scientist to realize anyone with a compromised or deformed penis is subject to more damage, and thus more plaque or larger plaque, the longer we wait.

I'm not surprised to read this because I was wondering if the size of the plaque had anything to do with how successful surgery might be.

I will be watching this thread closely. Thank you and good luck MeMO!

emasculated

There is this rule not to do an operation in the "active phase" when inflammation is going on.. I don't completely understand this rule but somehow I guess they (doctors) think by operating then it will cause the disease to get worse.. Otherwise it would indeed make sense to remove already a tiny plaque of 3 mm with a small incision, you wouldn't even need grafting material.
"Without health life is not life; it is only a state of languor and suffering - an image of death."

LWillisjr

The active phase is the first 12-18 months typically. And this is the period that Peyronies scarring could be worsening. So most surgeons will wait until the fibrosis has stabilized before during surgery. If you did the surgery before then you could still up with a bend afterwards as your Peyronies progressed.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

Shlomo

Hi, Memo.  I'm not a doctor either, but my guess is that the larger the plaque, the greater risk of unwanted side effects to surgery, such as erectile disfunction/impotence. Obviously I could be wrong.  Does this make sense to others who have dealt with this?

MeMo

I think I passed the active phase, my first pain was about 1 year ago which is disappear now. I agree that surgery should be the last choice but I am afraid that i have lost my last option in the beginning because of the plaque size.
I am on oral treatment but doubtful is it really working or not.
I read almost all the surgery posts of forum, there is no feedback about removed plaque size and post surgery satisfactory. so i think it would be very informative if people who underwent surgery share their experience to understand how the plaque size affect the results or how big plaques can be removed by surgery.
thank you all for your replies.

MeMo



james1947

MeMo

There are many reports/feedback regarding:
Quoteabout removed plaque size and post surgery satisfactory.
The posts are not concentrated but if you will invest more time you will find them.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

emasculated

In this article: Surgical Management for Peyronie's Disease

They state: "[...] Indeed, historically, total plaque excision was performed, which resulted in unacceptably high rates of ED.9 This outcome is thought to be related to veno-occlusive dysfunction as a result of structural changes involving the corporal bodies during erection.30 This practice has subsequently been abandoned and is not recommended. [...]"

So is it today standard to remove the plaque totally or only partially?
"Without health life is not life; it is only a state of languor and suffering - an image of death."

james1947

Most of the surgeons today are proposing incision and not excision.  
Yes, excision have a relative higher rate of ED.
Maybe emasculated can explain what the percentages means:
Quoterisk for recurrent deformity (0~26%), ED (0~53%), and diminished penile sensation (0~31%)
What is the real rate?

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Knight

And what if the Peyronies Disease sufferer is going with an implant? What difference would it make how large the graft is if the ED problem is avoided with the assistance of an implant.

If I choose to proceed I believe that will be my preferred option. If I'm going to suffer through the surgery and recovery I want to be BIONIC when its over.

Just a little humor there, but seriously the implant is what was recommended to me if and when surgery becomes the thing to do.

Can you find a qualified physician to do this MeMo? At least ask the questions?

james1947

Knight

I am with you on the implant 8)

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

emasculated

But I've also read that if the plaque is "ossified" there needs to be some excision / grafting before the implant can be fitted.
"Without health life is not life; it is only a state of languor and suffering - an image of death."

Knight

So be it! Cut out the bad stuff, install a graft and insert an implant. Done! Find me a qualified doctor and I'm signing up. I bet it would help MeMo too.

emasculated

Yes and with an implant Peyronies Disease is definitely gone for good! (I just feel like saying something positive because I don't want to appear too negatively. ;-))
"Without health life is not life; it is only a state of languor and suffering - an image of death."

james1947

Worm congratulation emasculated for your positive post ;D

James  
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

MeMo

As I investigated grafting surgery only is recommended for people who can get and maintain an erection (especially in hourglass cases); so the question is while someone can get and maintain erection (means No ED??) what he can get back with grafting surgery (exclude curved cases)?
- couple Cm in size?
- pre-Peyronies Disease shape?
- Stop probable worsening?
- Avoid new active phase due to ınjury on plaque?

In other word if the grafting does not cure ED problems what does it do to be worthwhile taking all the probable risks?

emasculated

I read in an article of Levine that expectations before such surgery should not be too high.
The goal is to restore ability for sexual intercourse.
"Without health life is not life; it is only a state of languor and suffering - an image of death."

james1947

I would like to hear opinions from people that had graft surgery, but I think the only thing you may get is the pre-Peyronies shape.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Knight

From what I understand grafting may actually CAUSE ED issues due to the fact that the materials used for the actual graft are imperfect and may leak. The way it was presented to me, by a surgeon, was the grafting would eliminate the plaque and the implant would prevent any ED complications.

I too would love to hear from some of the guys who have had similar surgeries.

LWillisjr

Levine is my doctor and he and I have had this discussion. His exact words to me were if you can achieve a good erection before surgery, then you should be able to after surgery. Of course there are no guarantees. I had excision and grafting meaning the plaque material was removed. The risk in the surgery is the location of the plaque, and the skill of your surgeon to operate and remove the plaque and not damage the nerve bundle which runs along the top of your penis from base to glans.

If you are not able to achieve an erection prior to surgery, then excision does not make sense. As this surgery will not cure your ED. In this case of ED, then an implant would be favored over excision and grafting.

I was able to achieve erections before surgery, and I had a 70 degree upward curve. Plaque was located on top about mid shaft causing the upward curve. Post surgery I was still able to achieve an erection and now perfectly straight. It took about 6-9 months to be completely healed. This was almost 6 years ago and I have had no complications since then.

Les
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

Knight

Thank you Les. Your story gives me hope. I'm thinking I should schedule a visit to Chicago to consult Dr. Levine.

I am still able to achieve good erections but I do have a nasty curve to the left with a clockwise twist that is very visible hard or soft. I have what feels like a quite large, hard, even sharp plaque right down at the base, on top, running all the way across from left to right that is mostly inside my body. It's very scary, it's not getting better and the discomfort is almost constant and quite unbearable at times.

I know surgery is the last resort but I worry in my case waiting might be the wrong approach. I worry if it gets much worse that surgery won't even be an option. I don't know if my concerns are valid, but they are real.

LWillisjr

If you are able, I think at least a consult with Levine would be good. Going to see him doesn't me you are going there necessarily for surgery. He will tell you your options.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

MeMo

As i understand grafting fix the curve for people who do not have ED problems to make penetration possible. so in hourglass cases is nothing more than high risk aesthetic surgery.
did anyone hear about aesthetic surgeries to fix narrowing without removing plaque??

also I found this article that I think is relevant to our discussion.


james1947

What is bothering me is that the article is from 1999.
I didn't find any news's regarding the technique they are detailing 15 years ago. :(

James  
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

MeMo

I found a study that an erectile tissue of Corpora cavernosa is used as grafting material. study is done in Iran. I have the full article but it is not English so I did not upload it.
They say that because this graft material is erectile and is taken from patient Tunica which is not involved in erection the satisfaction rate is significantly high. I have sent an email to authors and asked them about removed plaque's size. the English abstract is as follow:

Using tunica albuginea autograft from crural segment for the treatment of Peyronie: one year results
.
Abstract
Background: The etiology, pathophysiology and treatment of Peyronie's disease remain unknown.
Few medical therapies have positive effect on this condition. However, penile curvature is the major
symptom of Peyronie's disease, which can be treated by surgical reconstruction. There are many
surgical techniques for correcting penile deformity but there is the lack of a gold standard procedure.
We present a surgical technique to correct penile deformity in Peyronie's disease.
Methods: In this case series study, we treated 14 patients with stable Peyronie's disease with
significant curvature that precluded intercourse. We excised the fibrous area and the gap was covered
with a graft removed from the crural segment of the corpora cavernosa.
Results: In 3, 6 and 12 months follow-up there were straightening of penis in 92.8, 92.8 and
78. 2% of patients and acceptable erectile function in 100, 92.8 and 85.7%, respectively. Thirteen and
eleven of 14 patients were satisfactory with the cosmetic and functional result of surgery,
respectively. No severe perioperative complication was noted.
Conclusion: Present technique may be considered as a treatment option in patients with curvature due
to Peyronie's disease. Tunica albuginea auto graft from crural segment seems to be an appropriate
grafting material for this technique.  

james1947

Thanks for the article MeMo.
When the study was made? How long time ago? Are they continuing with this graft material?
Let us know the answer you get to your email.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

MeMo

James;
The study is done in 2012; 14 patient (48 years old in average) underwent excision auto-grafting surgery, the follow up period was 1 year. 13 of 14 are satisfied for the shape and size after surgery and 12 of 14 satisfied with erection condition (same as before surgery condition only two of them feel stronger erection and authors say it may be because of mental condition and stress before surgery).
I still wait for the answer about plaque size.

Knight

That's encouraging! Thanks for digging it up and sharing! As James stated, I wonder what materials were used in theses patients.

yyy

where do they take this corpora cavernosa tissue? from patients corpora? it sounds weird

james1947

Hi everyone.

MeMo opened this topic because the doctor told him his plaques are too big for surgery.
Can someone with surgery experience give him an answer regarding plaque size before surgery?

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

MeMo

@ yyy; yes it sounds weird but I have no complaint if it works ;)

@knight: they used erectile tissues from the patient's corpora cavernosa, they says grafting materials from patient body reduce the risks of ED and have higher satisfaction rate compare with synthetic materials.

@james: thank you very much; yes as he said it is very important for me to know did anyone had surgery with big plaques.

MeMo

Finally found an article which talk about factors can affect the result of surgery and how the surgery method should be selected regarding to the intensity of this factor.


Peyronie's disease: Use of grafts in surgical reconstruction | Urology Times

regards.
MeMo

Knight

Great article! Sounds like they have had a high success rate!

emasculated

It doesn't say how long they followed patients after operation. I also wonder.. if one is in the group with <10cm length left why bother with this severely invasive surgery? One gains at most 3.5 cm but can also lose up to another 3.5 cm. Sorry.. but honestly at some point it gets rather absurd.
"Without health life is not life; it is only a state of languor and suffering - an image of death."

MeMo

the author of autograft article (Tunica graft 2012) replied me, I asked him about relation of plaque size and possibility of surgery. his reply is as follow:

literary the plaque size is not restriction for surgery and patient with any kind of plaques can do grafting surgery. bigger plaque makes the surgery more difficult and surgeon should be more experienced. inherently, the risk of post surgery ED and venous lake increase in case of bigger plaques but not drastically. Also in case of big plaques we have technical limits to prepare autograft material from patient body. synthetic grafts can be used in these case. additionally, you can remove the plaque partially and use autograft.

Shlomo

Memo, it sounds like you have finally found a good answer to your question.  The size of your plaque does not make surgery impossible but makes it too difficult for your particular doctor to handle. So there is hope. You should find the most skilled peyronies surgeon available.  Either the one recommended on Dr. Gelbard's site, or you might need to go to Europe for it.

MeMo

yes and now i am looking for the right surgeon; during visit safarinejad he showed me his data base he has more than 10.000 Peyronies Disease case. I think he would be a good choice. I have more than one year to make this crucial decision. if my situation stay the same I will do this next year.
I think doctors who have experience with Peyronies Disease and transexual surgery are the ideal choices (They create it from nothing).
 

Knight

Good point! I had never thought about that before your post but there could be some merit to it. I'm also 5 or 6 months into a 1 year holding pattern debating surgery. I have good days and bad, it's a tough call. My plaque has never been measured but it is substantial. Good luck MeMo!