Feb 26 plication - Documenting my experience

[AeroT]

Well, I've been sitting around for the last few days (currently 3 days post op) with an ice bag on my crotch and really not much to do. I've been browsing these forums and found the stories of others experiences very helpful in providing some idea what to expect with the long-ish healing process. So I figure I would provide one more data point and document my experiences for the benefit of others either considering this or currently going through the same thing.

background:
I am 26 y/o with congenital curvature of ~30 deg down and to the side. While the total angle is not that severe, the curvature being in the downward direction and having a very immediate inflection point about halfway down the shaft made things difficult. So I did some research and decided it was worth getting fixed.

I am not quite sure exactly what the official name of the procedure was, but it was a plication/excision of the tunica opposite of the side of curvature with access gained through a linear incision starting at the base of the penis and moving lengthwise along the shaft. In my case since the primary curvature was down, the incision was made on the top. (It seems this is a bit different than the more common circumcising incision made just above the glans.) This linear incision approach was taken after some lengthy discussions with my doctor due to the fact that I was uncircumcised and wanted to remain that way. So this was recommended as the best option with the lowest chance of wound complications, with the only drawback being the slight cosmetic issues of the scar.

Surgery day:
Showed up at 6:30am got quickly checked in and prepped by the nurse -- which included the insertion of an IV line -- then was left for another hour until surgery. This was sort of nerve racking as I really don't like having needles or tubes stuck AND LEFT in me and to make it worse there was no TV or other forms of distractions. So basically I was in a room by myself with nothing to do but focus on the line stuck in my arm. Anyways things got much better when the anesthesiologist showed up and asked me if I wanted my "party hat". Yes please. The surgery started at 8:30am and completed around 12:30pm and I was then put into the 23hr observation phase (basically stayed at the hospital overnight). I think this was necessitated by the two drain lines that were inserted in my abdomen and traveled down to my penis (did I mention I hate stuff stuck inside of me) which had to be removed the next morning. The IV was also left in and to top it all off I was "blessed" with a catheter. I would say I felt every minute of the 23hrs of observation, probably one of the most uncomfortable experiences of my life. Thankfully there was virtually no pain, the only pain being at the sites of the IV, the drain lines, and of course the catheter, which were really not THAT bad, but psychologically knowing they were from tubes poked into me made it worse. The next morning came and the doctors seemed to be extremely happy with the way things looked. There was virtually no swelling/bruising, the incision was very clean, and everything looked pink and healthy. -- Maybe that's the payoff of those god awful drain lines.

Day 1:
With the doctors blessing I was allowed to go home. I felt so much better after having all the lines removed -- which by the way was another horrible experience. The catheter has some stupid bulb thing on the end which you can feel dragging every inch of the way, and on the first drain line to come out, the resident accidently left the suction on so it was still sucking at my insides as it came out, which was EXACTLY what it felt like. I was surprised afterward at how little pain I was in though. I had stopped all pain meds by ~4am in anticipation of driving home around noon and didn't need them since. Painwise, I'd say everything was extremely tender to the touch, but if I found a comfortable position to sit, there was little discomfort to report. I came home with a plastic adhesive bandage that I think must have been shrink-wrapped on based on how tightly it conformed. It did a very good job at holding everything together and provided good resistance against any erections that I got. I think it must have also helped with reducing any swelling. I took the rest of the day very easy, mainly just laying on the couch. I was dreading falling asleep due to the inevitable night time erection. The doctor gave me amyl nitrate inhalant which is a fast acting solution to kill the erection if one occurs. So I kept those close by. I am a pretty light sleeper, so I was able to quickly get on top of any erection without very much pain.

Day 2:
Felt mostly the same as the first day. Felt well enough to walk around and also go into work for a bit. I was also supposed to remove the dressing and take a shower. This was pretty tedious since the plastic bandage was extremely sticky. So had to take it very slow, making sure not to open the wound. It took some time but came off without issue. Jumped in the shower and got my first good look at the wound. It looked extremely clean. There was no sign of blood at all and it almost looks as if the skin must have been tucked in a bit. It sounds weird, but I think the best way to describe it is by looking at the seam that attaches a T-shirt sleeve to the body of the skirt, and imagine that was skin. By this point some bruising started to show up on one side, but overall pretty minimal. The skin was also only very mildly swollen. Slept again in kind of a napping fashion, waking up at any sign of erection pain. At times it was kind of frustrating because I could tell the instant I closed my eyes a throbbing pain beginning to form from "down-under". Thanks to some of the advise here, I found that chilling things down with an icepack before attempting to sleep usually got me another few hours.

Day 3:
I'd say day 3 (today) has been almost an exact copy of day 2 in terms of level of pain and visual appearance. I guess one other thing to note is that as far as I can tell, sensations in my glans has been pretty much unaltered*. I've only tested this with a gently prodding finger though.

*Though if I gently press on the top of the shaft (where I assume one of the placations are) it feels like I am pushing on my glans... Weird.

Overall, I am happy so far with the experience. I have yet to see the actual results of the straightening aspect of the procedure, but I imagine it will be a week or so before I am able to bear the erection to observe it.

Also another thing I wanted to note, in hindsight I am VERY happy with the linear incision approach and it seems to have a number of small benefits which may be worth considering for those uncircumcised (and if your doctor supports this):
1. It is very easy to keep dry and clean.
2. My incision measures ~2.5" (flaccid) which is significantly shorter than the ~4" (flaccid) required to go around the shaft circumferentially.
3. I suspect any lack of stretchiness of the scar should be a non issue (if uncircumcised) since the skin doesn't need to stretch lengthwise.
4. Hopefully any sensitivity of the scar should be less of an issue during sex as it should have only light contact (if any) during penetration.

I'll try to continue posting my progress over the coming weeks.

[james1947]

AeroT

Thank you for the detailed post.
It will help other while deciding about a surgery.
Wish you excellent outcome and fast recovery.

James

[AeroT]

Day 4:
More of the same. Appearance looks unchanged and I am noticing the pain is continuing to improve bit by bit. I am now able to move around pretty much normally with only slight discomfort. The incision being on the top does rub against the clothing a bit, but it is not too bothersome. I may try covering it lightly with some gauze tomorrow. Sleep has still been very disturbed by pesky erections. I think I manage to get ~2-3hrs of sleep at a time before I have a "situation" to attend to. I've still been managing to catch them in time before experiencing any severe pain thankfully, and the ice has been enough to keep things under control. In the morning I was curious, so I decided to let one of my erections go a bit, just to the point where I could feel it would become painful. I found that if I supported it in its natural "neutral position" I could tolerate maybe a ~2/3's erection with little pain. This was more than enough to get some good rigidity and see that so far it was actually straight! So I am encouraged that all this pain, time, and effort may pay off in the end. For now just have to take it one day at a time.

[WestCoast]

AeroT - glad you've written all this down. I know these 'journals' were a big help for me, and no doubt for other visitors!

It's awesome seeing everything straight for the first time, huh? Makes the discomfort worthwhile.

Anyhow, I wish you very prompt recovery and easing of pain. Personally, nocturnal erections became bearable within a couple (long!) weeks; they didn't even wake me after about three weeks, as I recall. Given our similarities of age, direction and abruptness of congenital curvature, and surgical technique, perhaps that will be the case for you, as well.

All the best,

WC

[AeroT]

Haha yes it is, its amazing! Getting to see everything straight is sort of the silver lining behind every painful night time erection.

Man three weeks!! That feels so far off... (its only day 5!) but I guess I knew the process was going to be slow. I am happy at least that the worst is over and indications so far are pointing to a good result. That's good to know though, so thanks.

Also, thanks both of you for the nice wishes.

Day 5:
I think at this point the rate of progress between days is beginning to slow. Swelling is nearly entirely gone. The bruising is about the same, maybe darkened a bit. The incision is almost entirely pain free (pushing and rubbing it creates little discomfort). Overall though everything is still very sensitive; ill get a dull ache if bumped to hard or squashed. Nighttime erections have gotten a bit worse. They are about the same frequency, but they are a bit harder to control. I don't know, maybe the pain is a bit less or I actually like seeing the erection, but I had to use the amyl nitrate to finally get one of them under control.
 

[Johniscurved]

I do recall being told via email that as of now it is very much possible to keep your foreskin with STAGE as they tailored the technique to accomdate certain preferences as demand grew. It's supposedly done in the vascularised tissue behind the retracted foreskin leaving a small, usually non visible scar that heals well due to the nature of the skin there. So that's good news for some!

[AeroT]

Day 6:
Everything is about the same today as yesterday. Only minor discomfort during the day, but no pain, which is nice. Went to the gym today for some upper body workout, also had no pain or issues. Sleep is still very interrupted; erections again got even worse. Amyl nitrate on two occasions and one of them it didn't really work... I think this is my body's way of saying tanks are full and in need of "service". Maybe the hardest part is not over yet!

[james1947]

AeroT

Your erections are an excellent sign that no nerves were damages during the surgery.
You should be very happy for that.

James

[AeroT]

James, yes definitely! I've read some of the unfortunate stories that can happen and am very thankful to not have to deal with that, and also that signs in general are indicating a good result.

Day 7:
The 1 week mark, yes! Time feels like it's going so slow, yet the healing has come a long way. I am still noticing an ever so slight improvement day by day and definitely noticing an improvement in the pain experienced during erections. It still hurts like crazy when they come, but they are able to reach a fuller state before becoming painful. - In other words, I used to be waking up in excruciating pain with a "chubby", now I wake up in excruciating pain to a nearly full erection. Tomorrow morning I have my first real post op checkup, so we'll see if I hear anything new or of interest from my surgeon.

Length, Girth, Straightness, Etc...:
With erections becoming fuller without pain, I spent some time examining the results in more detail. Straightness has exceeded my expectations. Not only did my surgeon produce a perfectly straight result, but somehow improved the symmetry as well. Initially I had a slight curve to the right that seemed to be due to a left corpos canvernosos that was both larger in length and diameter. Now the curve is completely gone, and the diameters are nearly identical; pretty awesome. It is probably too early to give the final verdict on length as I am not quite reaching a full erection yet, but its clear there will be a loss in length. At this point I am getting to about 87% of my original length and my feeling is that with a solid erection I'll probably get back to ~93% of my original length. I think this is right in line with the expected loss, but a little higher than I was expecting for CC of only 30 deg. With that said, I'll take this result any day, even if I didn't gain back any more length. Girth has definitely increased. The right side, which as I said used to be smaller, now almost matches the chunkier left side, which also feels like it got even more chunky. Now its to the point where my foreskin has a hard time retracting and ends up kind of scrunched up against my glans. This will require some stretching but shouldn't be a problem to sort out. (I used to also have phimosis, so I am no stranger to stretching out tight foreskin. Oh the problems I've had...) All in all, I am super happy with the results so far, and am really excited about the transformation that has taken place over the course of just a week.

One other thing I noticed, which will probably go on the "Cons" list for the linear incision, is that the skin seems to be adhered to the tunica at the site of the incision. There must be internal scabbing or something that has caused this. Hopefully the skin is not physically healing and attaching to the tunica. Its a bit of a nuisance at this point as the skin now doesn't move very freely. We'll see how this plays out, whether it frees up on its own, or requires some exercising to loosen up again. I'll probably ask the doc about this tomorrow.

[BoatFool]

Who is the surgeon?

[AeroT]

My surgeon was Dr. Gelman at The Center for Reconstructive Urology, located on the UC Irvine Medical Center (just outside LA). Note, it is a teaching hospital, so if you do the 1 day observation stay like I did, you'll have nervous med students and interns poking around down there during rounds. If you are uncomfortable showing your junk to strangers, just remember, they are probably more afraid of the situation than you are! But anyways, being at a teaching hospital is probably part of what makes the care so great. I'd say overall it was a top notch team at a top notch facility. -- highly recommended.

Day 8:
Just had my first post op checkup with the doctor. Yet again he seemed surprisingly excited about the results so far. The incision looks very clean, it is clearly starting to close up, there is little bruising, and swelling has long since gone. He was also super happy to hear that so far everything is 100% straight and that at this point sensations were very nearly normal; definitely no numbness to report. He gave me some of the standard info -- no sex for 6-8weeks, contact him with any Q's, etc... -- then sent me on my way. As far as progress goes, things have been continuing to progress slowly. Pain again slightly better. Sleep is still very interrupted. Really just looking forward to the point where erections are no longer painful. Besides the erection pain though, I'd say life has returned to normal.

[james1947]

Good to read your post AeroT
Everything seems going in the right direction I understand.
From reading your posts, the longitudinal cut the doctor done is much less traumatic then degloving.
I added your surgeon to the doctors list.

James

[AeroT]

Yeah, I think the linear cut definitely has its benefits. I think the drain lines used during the 1 day observation phase also helped; I'd say they removed ~1/8 - 1/4 cup of fluid which would have otherwise been swelling. The other thing that helped, which I didn't mention before, was that during surgery all of the sensitive nerve bundles that line the tunica were carefully dissected away - via microscope - before any cutting or plicating was done. This helped minimize any trauma to the nerves (since now you aren't cutting through them) and was probably the key reason sensations were unaffected.

Day 9
Day by day changes are still nearly imperceptible, but when I think back a few days there is definitely an improvement. Erections are of course still painful and still bothersome, but I think I am starting to hit that crossover point where it is less disruptive to my sleep to just tough them out rather than fully wake up to ice or use the amyl nitrate.

[AeroT]

Day 10
Sleep last night was horrible... I could not count how many night time erections I had, but I'd estimate it was in the 5-10 range. At this point, I am not even sure if they were individual episodes, or more like one constant erection. The term "blue balls" comes to mind. Without going into too much detail here, this morning I decided to take things into "my own hands". I took extreme care being really gentle -- things were on a hair trigger so it didn't take much anyways -- and lets just say I now have a spring in my step and a smile on my face. I think it is also worth noting that having things straight provides noticeably less flow restriction which was also pretty cool. I noticed things felt to flow more freely and there was a definite increase in velocity and flow rate over the norm. Anyways, we'll see how sleep goes tonight.

[james1947]

Wish you to sleep wheal AeroT. I know is annoying to wake up 10 times a night, but again, it is a good sing that the surgery didn't damage any nerves.

James  

[AeroT]

Thanks James.

Day 11
Not much new to report today. Pain levels are about the same. Sleep disturbance is about the same. I have noticed the incision at this point has completely closed up. In some spots if it weren't for the stitches, it would be hard to tell it was even there. Clearly there is a lot of healing left to do underneath as erections still produce a lot of pain.

I may wait a few days before my next update since progress is really starting to slow. I've been really surprised at how far things have come along in just over a week, though. At this point, I just need the erection pain to go away and things will be pretty much back to normal.

[AeroT]

Day 14
I'll probably just update weekly now. Hit the 2 week mark, finally. I think having everything healed up and pain free during the day has helped make things go a little bit faster. I am not always thinking about it. The status at this point: no swelling, no pain from pokes and prods, incision is closed (a bit sore and still has stitches though), still some discoloration from bruising, sensations are nearly normal (just a bit of extra sensitivity if anything), and still very painful erections. To elaborate on this, the pain at times can still reach similar levels as before, but it now only occurs during extremely solid erections. So that's a bit of an improvement I guess. I hope as I near the 3 week mark, these erections stop waking me up at least, as westcoast said.

[AeroT]

Day 21
Just hit the three week mark, half way through my prescribed recovery time! So I figure its worth another update. At this point, I feel like things have started to turn the corner. Just as WestCoast suggested, erections have started to become much less painful. The last few days my sleep has improved to the point where I would only wake up maybe 2-3 times and the feeling was more of discomfort rather than pain. So it was pretty easy to just ignore and fall back asleep. Bruising discoloration is gone, sensations are 100% back to normal, and the wound is completely healed. Stitches are still firmly in place though, not sure how long these are supposed to stay? Ive also noticed under the skin that there is what feels like a piece of thread floating around. its kind of weird. It definitely moves around, so I wonder if the internal stitching has started to dissolve and this segment just got dislodged. Well hopefully this dissolves too, otherwise I'm going to have to live with this, or go in for a recovery mission.

As far as my erections go, they are still perfectly straight, which is awesome. I have gained back a bit more length since I last reported and am now to ~90% of my original length when erect, and ~94% when stretched. Before surgery the two measurements were about the same, so it is interesting how now I am longer when stretched. Also I do get a feeling of being a bit "bunched up" when I am erect, and I am wondering if this all may be due to the plications not being completely perfect at evenly removing the excess length. I am thinking/hoping a few months of stretching might help even things out as well as get back a bit more of that erect length. Another interesting thing worth noting is during extremely hard erections I get an ever so slight upward bend. Its as if the side that was plicated is now not as stretchy; again wondering if time or stretching sorts this out.

[AeroT]

Day 28
Four weeks down. I feel like each week continues to go faster and faster. Again a pretty noticeable improvement from last week as well, which is surprising to me actually. At this point erections are virtually pain/discomfort free. Still a bit sensitive to press on, and can be a bit painful if forced in an awkward position (like with clothing on). Most importantly though my sleep is practically disturbance free. I'd say my biggest complaint are the stitches used to close the incision. A few have fallen out, but the majority are still firmly in place. I am surprised at how long these stay, especially considering the incision has long since healed. Its kind of annoying actually since they are still sensitive to push against and sting if they get tugged on, so really they are the only painful aspect left with regards to the incision. Hopefully they finally start falling out soon.

Another thing I've noticed is that there are distinctly hard spots on the tunica where I assume the plications were placed. In some spots there are harder patches, and in others there are noticeable bb sized bumps. I imagine this can be due to any one or a combo of scaring, scabbing, clotting, and stiches. Its only really noticeable when flaccid since everything else is relatively soft. When erect its nearly imperceptible. interested to see if it clears up a bit though. My GF (primary care doc) mentioned the hard bumps are likely "superficial thrombophlebitis", which are little clots that form in smaller veins and are pretty common as a result of surgery. I also had one show up in my arm at my IV site (also common) that has exactly the same feel. Apparently these will take a bit of time to clear up if that's what they really are, which I am hoping.

As an update on that "string" that I thought was floating around, I am now pretty sure it was just a small vein that was a bit inflamed or something. It also seems to have started to clear up, but still noticeable.

As far as my erection goes, its still about the same as before; nice and straight with, if anything, an ever so slight upward bend. Not sure if this will reduce a bit if/when the harder patches at the plications soften up. Personally, having gone through life dealing with the difficulties/frustrations of a down bend, I'll take the up bend any day. And really I'd say it is less than 5 deg so for all practical purposes, its straight. I have started to do very light traction exercises, just using my hands for ~15min a day. Not enough to get that sore or anything; I'd say the stretching is more in a therapeutic way vs. actually exercising. I think it has helped gain back even more length to the point where I am back to ~92% of my original. As I've said before, I am not really banking on gaining ANY back, but I am still interested to see how much I can recover. Right now though, I'll take it slow since the number one priority is still to heal.

Obviously it hasn't been all pleasant and smooth sailing, but I'd say overall I am still extremely happy with the experience and results so far.

[james1947]

Thank you for the update AeroT.
Your surgery/recovery record will help others for sure if they decide to go on your way.
It's more easy if you know what to expect for.
Wish you continue a fast and full recovery.

James

[AeroT]

Thanks James.  

Day 35
week 5! I'm getting pretty far along now, just one more week before sex is ok, yes! Another decent improvement over last week, though at this point there is very little left to improve upon. Its very hard to produce pain/discomfort of any kind now. Only if I get an erection that is really jammed up in my clothing or something, but I am not sure if those situations would cause pain anyways. The hard spots and bumps are still there though and are still a bit sensitive to press on directly. I suspect this aspect will take quite a bit longer to improve, and may never be 100% "back to normal" considering its a byproduct of surgery.  

I think it was the day after my last post, I took a closer look at my stitching and came to the conclusion that they were not dissolvable stitches. Basically I was waiting for them to actually grow out of my skin, which is what was taking so long. So I decided I was going to just cut them out as that would probably be less traumatic then waiting for them to fall out -- or more likely get ripped out -- and I could have them out immediately. At this point all of the stitches had grown out to the point where the loops were partially exposed, so I used the scissors in my suture removal kit (which had very pointy tips) to carefully cut one side of the loop so that the stitch could be easily pulled out. I had about 15 left, and they all came out pretty easily. It felt really good to finally have them out. I also think this helped the incision heal a bit better since it didn't have little threads interlaced and moving around. The incision itself is now becoming just a faint white line. The most noticeable aspect at this point is a pink discoloration directly around the scar.

The inflamed vein that I thought was that thread has completely resolved.

I've begun to step up my traction exercises, letting my body dictate the right pace. Again, I just use my hands, and I have been just doing ~15 minute sessions twice a day, applying traction for ~30sec then resting for ~30sec. I have increased force to the point where I have very minor soreness afterwards, which at this point doesn't take much. If I am still sore the next day, I will take the day off. I have managed to again recover more erect length, so that now I am back to ~96% of my original. I suspect most of these gains are easy gains associated with stretching out length that may have been a bit "bunched up" after surgery; I do think some of this may be new length though.

 

[james1947]

AeroT

Your sentence below is amazing:

I have managed to again recover more erect length, so that now I am back to ~96% of my original.

Everybody, including the surgeons are saying that following the surgery you will lode length!!!
And here are you, 5 weeks after surgery and saying you are at 96% of your original

James

[AeroT]

Yeah it has definitely exceeded my expectations. My results may not be typical considering I was just correcting 30 deg of congenital curvature, which isn't much angle, and I don't have that double loss first from peyronies then from the surgery.

[AeroT]

Day 42
Wow week 6, finally. The GF and I couldn't wait, so we "christened" my new member a few days early. There was still a bit of soreness, but very minor. Besides that everything else felt and worked just like normal. Oh and it was amazing to finally have everything straight.

In terms of healing progress, there was virtually no change from last week. I think at this point there is nothing really left to improve. Just the hard spots as I mentioned before, and a bit of soreness after each "use". I think these aspects will likely recover over a more extended time frame.

I'm still doing the traction exercises but no change in length to report for this week. This will probably progress much slower, if any, at this point.

I think this is going to end my regular updates since there probably wont be lot of new stuff to report. i'll still try to drop back periodically if there is anything new, or just to give a general update. I dunno, maybe to wrap this all up I'll post the "before" and "after" shots in the pictures section; we'll see if I muster the confidence.

Overall, I am extremely happy with the experience. It definitely wasn't easy, but the sacrifices appear to have been well worth the pay off.  

[james1947]

Glad to read your post AeroT.
I would like to ask you to open a topic on:
Improvement - Accounts of improvements in deformity or erection. - PDS - Peyronies Society Forums
We don't have too many posts there Many members just gone away without posting there so the board is not too encouraging someone that reads it.

James

[AeroT]

Posted my pics to the photos boards.

Just received the bill today. Total out of pocket expenses came to ~$3.25k. Not bad. On the bill they also itemized all of the raw expenses involved: Surgery, anesthesia, and the 24hr hospital stay which altogether came out north +$50k!!   Thank goodness for insurance...