Patch Corporoplasty

[DannyOcean]

I'm sure this has been discussed here (perhaps under a different name) but I've studied Peyronies Disease for a long time and came across it for the first time today.

http://www.ncbi.nlm.nih.gov/pubmed/12576826

This was the article that lead to this and in it, the author claims that it "fixed" him.

http://www.menshealth.com/health/peyronies-disease

Thoughts?

[MikeSmith0]

it's not that different from standard grafting surgery except for the material used is the sapehnous vein (same vein used for coronary artery bypass grafts).   it seems like the outcomes are similar for people who get grafting with this and grafting with non-human processed tissue (e.g. cow pericardium)... there's always going to  be risk of length loss, risk of recurrence, risk of ED, and risk of numbness in any grafting surgery.  im sure that doctors who use the saphenous vein will tell you why pericardium is bad and doctors who use pericardium will tell you why the vein graft is bad.  

i wonder if this has  a more natural feel, though...the texture may be more similar to the tunica albugea than a graft from a non-human source...not sure.

[chefcasey]

can anyone tell me why you lose length with any type of grafting surgery?  It seems like you should re-gain length, since the graft is more flexible than scar tissue.

[MikeSmith0]

I've been told this is because it heals in the flaccid state and the body creates more scar tissue and contracts the penis more.   It's not peyronie's scar tissue.  It's surgery related.   The grafts also contract.  The surgeons claim that they cut the grafts to be larger than the area so this contracture is minimized, but it's not foolproof...and then you have the weird feeling of the graft and sutures under the skin.   I think levine has people use traction for months after surgery (after the healing period) to regain some length lost in the surgery.

Guys with implants generally are left semi-inflated so the penis deliberately heals in the erect (or semi-erect) state.  This depends on the surgeon though.

[chefcasey]

Yea I guess that's one advantage of having the implant.  Over time you can regain most of your lost dimensions.  I just figured if you had scar tissue that caused you to lose an inch or more, replacing it with the flexible graft even with surgery shrinkage, shouldn't leave you any shorter than you were with the scar tissue. But then again, I've heard stories of guys losing up to 3 inches, which I think is insane and makes me hesitant to even think about it.   Does anyone know if you lose less with incision and grafting vs. excision and grafting?

[LWillisjr]

The surgeons claim that they cut the grafts to be larger than the area so this contracture is minimized, but it's not foolproof...and then you have the weird feeling of the graft and sutures under the skin.

I have read where you can feel the sutures from plication surgery. I don't know at any (including myself) who have had excisoin and grafting where you feel the sutures. I was never able to feel the sutures, and also hard time even feeling or finding the graft.

[MikeSmith0]

The surgeons claim that they cut the grafts to be larger than the area so this contracture is minimized, but it's not foolproof...and then you have the weird feeling of the graft and sutures under the skin.

I have read where you can feel the sutures from plication surgery. I don't know at any (including myself) who have had excisoin and grafting where you feel the sutures. I was never able to feel the sutures, and also hard time even feeling or finding the graft.

oh thats good. i must have confused plication with grafting.  there was a surgeon who told me to be prepared to feel the grafts and i should manage my expectations, btw... this was not levine.  maybe he used different graft material. what did you have - pericardium?

[LWillisjr]

oh thats good. i must have confused plication with grafting.  there was a surgeon who told me to be prepared to feel the grafts and i should manage my expectations, btw... this was not levine.  maybe he used different graft material. what did you have - pericardium?

Human pericardial tissue.

[MikeSmith0]

lwillisjr, thanks - did you lose size in length or width?  

[LWillisjr]

lwillisjr, thanks - did you lose size in length or width?  

Overall lost a little over 2 cm in erection length. But as I have stated before, this was in comparison to my pre Peyronies Disease symptoms to my post surgery results. So I don't know how much may have been attributed to the surgery, or how much was attributed simply to the Peyronies Disease.

Les

[MikeSmith0]

Thats not too bad - especially compared to pre-peyronies length...So, then was it a gain to what you had when you unbent it?  Also,  Was girth the same or did that not ever change during the whole process?  

[hunchback]

if anyone here has had this done i would like to know long term how it has worked out or if you know of any longitudinal studies. it is one of the options i am researching and considering.

[Luciano]

i do not think its only the quality of the graft material, its also the skill of the doctor involved.
in ressources section i had posted an incision and grafting method used by tom Lue.
http://healthcare.utah.edu/menshealth/files/SVG-BJUI%202006.pdf
if you scroll down to the grafting material, there is a part where it says:

Vein has the least contraction of any of the
biological graft materials; it is easier to tailor
other graft choices to size

But in the graphics you can see how difficult the tailoring of the vein is.

So i think the surgeon doing this for the 5th time, will find it much more difficult to do than tom lue, who probably did it allready over 100 times.
So maybe ( I actually dont know - but I imagine) that a less experienced surgeon will have better results with graft material that has a bigger surface to start with.

thats just an Idea

But then again, I've heard stories of guys losing up to 3 inches, which I think is insane and makes me hesitant to even think about it.   Does anyone know if you lose less with incision and grafting vs. excision and grafting?

Well what I heard (when it comes to grafting) usually you gain size compared to what you had prior to surgery. BUT you might still lose compared to prior to Peyronies Disease.
Example: if you lost 5 cm through peyronies, you might gain 2 cms through surgery, but you still will have lost 3 cm.

What I heard is it all depends where the plaque is placed.

In some cases (like me) excision is not even possible. The plaque is not calcified, it is somewhat diffuse and everywhere giving the hourglass effect.
also doc told me:
Nesbit and similar methods will make you shorter than you are now!

Any kind of grafting will make you gain length and girth compared to now. BUT it will still be shorter than before.
why??? I asked .. because  by removing tissue or plaque (excision) you will not be able to take everything out.. (only the major part.) so where the sutures are, and on the edges you still have less strechable tissue.
And with incision the plaque is still there. so yes, you will get bigger.. but you will in most cases NOT be able to reach the exact same size you had before Peyronies Disease
At least thats what my uro told me.

He also noted that size gains and losses depend on where the plaque is located. I have some that goes right under the gland... this will never be possible to remove he says. Thats why he recommended incision for me AND he also told me: as the plaque that goes under the head (gland) cannot be touched, you will not be able to recover size in those areas. but where the plaque is on the shaft, there you will experience some gain.

But i am still scared and mentally not ready yet!

Luc

[mike67]

Adding to Luciano's post
I just wanted to let the members know that after much deliberation and discussion with my Peyronies Uro , Dr. Ethan Grober at Mt. Sinai Toronto , I yesterday booked my surgery appointment for early Feb. I hope I am not premature in posting this in the event I might change my mind and be embarrassed in rushing to tell the world.
I have been following the Pentox etc & VED protocols for 1 1/2 years with no improvement whatsoever. That is just me and I don't mean to take away from anyone's treatment.
I  have a very difficult 90 degree complex bend  and the only sure way to fix it was surgery. I will have Plaque Incision & Graft using a SIS graft. You can look it up on the web.
Small intestinal submucosa. ( from Wikipedia)
SIS is a naturally derived, extracellular matrix based biomaterial. Easy to source and process, SIS also provides a rich environment that signals the body to repair itself. SIS provides the temporary strength or filling necessary for the immediate repair, but also signals the surrounding tissue to grow into and around it, gradually replacing the SIS with native tissue that has the necessary properties to continue the repair. Ultimately, this leads to a functional, long-lasting repair without the presence of a permanent foreign body that can cause problems years later. The use of SIS or biomaterials like SIS represents the future of medicine working with the body's own repair mechanisms instead of simple patching.

The doctor also has his procedure on YouTube and I believe Luc , you viewed it earlier.

His procedure is covered in detail on YouTube. There are two artificial erection injections during the procedure to check on the degree of bend.
This is a specialty of this Urologist.
There is a preop appointment 1 week prior where I will get the usual blood work etc plus more than likely an ECG due to previous Quintuple Coronary Bypass in 1987 .
Then day surgery with total anesthetic.  I am to remove the bandages at home after 36-48 hours.   Then a follow up 3 weeks after.

That's about it. I would welcome any comments/advice either here or feel free to send me a more personal PM.
Mike

[GS]

Mike,

Best of luck to you and if you change your mind, you shouldn't feel any embarrassment whatsoever.

I too am in a long term relationship with the VED/Pentox therapy.  I do, however, feel like I'm making progress.  It's been very gradual...but, progress with this disease is hard to come by.  

Again, good luck, and keep us posted.  We may all end up where you are now and hearing a positive result would give us all some encouragement.

GS

[Luciano]

Hey Mike, wish you all the best.
I understand this is a difficult decision, so dont be embarrased IF you change your mind. Just follow your feeling. And I think you dont have to be embarrassed if you change your mind.
Anyway, I think that all of us here wish you good luck!

Luc

[mike67]

Thanks Luc and GS.  Much appreciated.

[LWillisjr]

Mike,
Let me know if you have any additional questions. I will help support you through this as best I can.

Les

[0x5555]

Best of luck Mike67.  You've helped a lot of guys on this site.

[mike67]

Just a note to mention a couple of things I asked my surgeon regarding the operation. Perhaps it will be of interest to some of you guys.
I am having the plaque incision & graft .
Why plaque incision vs excision ? to release the tension causing the curve, usually it only requires a plaque incision.  Excision removes the plaque but can leave a large defect with increased nerve injury and risk of ED

Just want to share this with you.
Mike

[Luciano]

Just a note to mention a couple of things I asked my surgeon regarding the operation. Perhaps it will be of interest to some of you guys.
I am having the plaque incision & graft and asked him again , why not the excision and also about side effects.
Here FYI are his responses :
1) How many of these plaque incision ops have you performed?  about 30-40
2) What about loss of sensation and ED ? I have not seen permanent sensation loss, ED - about 20% of men will need some help with erections - usually with viagra like medicines
3) went unanswered - can you give me a reference to call a previous patient ?
4) Why plaque incision vs excision ? to release the tension causing the curve, usually it only requires a plaque incision.  Excision removes the plaque but can leave a large defect with increased nerve injury and risk of ED

Just want to share this with you.
Mike

Wish you all the best mike.
The method is certainly good. Interesting is also the graft material he is using. Just posted an evaluation of different types of surgery in the ressource library. They say the incision with graft is state of the art nowadays:

https://www.peyroniesforum.net/index.php/topic,2149.0.html

at the bottom of the post there is also a link to their download directory and in there, there is a pdf document comparing the different grafting materials and their respective issues.
here is a direct link to the document:

http://www.uroandrologiaricostruttiva.it/downloads/General_principles__Grafting_for_corporoplasty.pdf

it is interesting to read when deciding on operation using graft material.

But if I read your post correctly, you are getting the best surgery possible.

Luc

[Luciano]

Hey mike,
Maybe i overread a post of yours.
How did surgery go? did you have it done?
Luc

[mike67]

Luc
Thanks for asking. You are on my list to contact and just read your post. So for the benefit of all my friends who have contacted me and everyone else , I just want to say that I survived my surgery 1 week ago on Feb 2 , 2012 . There was a big debate with the anaesthesiologists as to whether I should have an Epidural . I declined as they said the risk for me was about the same for either - due to my coronary blockages and history of quintuple bypass. I obtained a letter of approval from my Cardiologist so that helped .
I had Plaque incision & SIS Graft. In addition , Dr. Ethan Grober , my surgeon and Urologist at Mt. Sinai in Toronto , told me ahead that he would probably also do a Plication on the opposite side of the scarring.
The initial artificial erection showed that I had a significant 60 to 70 degree right curvature with a hinge like effect.   A second induced erection showed  my penis was significantly straightened with just a slight residual right curvature . They took care of this with a small left  plication .
So I actually had Incision with Graft plus a plication. My doctor told me that the final artificial erection showed a very functional straight penis.
In the recovery room at about 2:00 pm I was able to urinate. Otherwise they would have to reinsert the catheter. I was kept overnight due to my Cardiac history and was very closely monitored.
Went home Friday morning after seeing the other surgeon. Dr. Grober had already seen me a few hours post op on Thursday and explained everything that they did to me during my surgery.
They sent me home with pain pills which I took 4 x daily til Sunday then cut back to 1 x 3 per day. Then none as of Wednesday. I removed the bandages in the shower on Saturday morning. During the night I had to loosen the elastic  wrap as it was causing a bit of a problem urinating.
  I am feeling fine. Just the normal residual swelling around the tip stitches. Alopurinol is to be applied 2 x daily.
Five days post op I had my first night time erections Wed. night. One at 2 am , the other at 4 am. Very painful. I stayed up after the 4 am erection. Glancing at it , saw it was straight.  
Anticipating a painful erection recurrence, I took a sleeping pill the following night , as well as 2 of the pain tabs. I didn't wake up til 6:30 am today and felt nothing.
  But I want to know if there are erections because my stitches haven't totally healed and erections at this stage can be risky. So I want to be aware so I can reverse it quickly.
I can't say enough good things about Dr. Ethan Grober and his team. Everything went smooth. He is quick to respond to all my questions.
He  gave me a Rx for a 5 day dose of antibiotics to ward off any infection that may occur. My post op appointment is Feb. 24.
I plan to write up "my story" and post it soon but I wanted you to hear the news and that I am very happy and so far pleased with the outcome. Final outcome will be later as we see how everything settles.

Mike  

[KAC]

Thanks for the detailed update.  KAC

[Luciano]

Congrats Mike, I envy you!
Very interesting.
specially the use of SIS graft. first time i heard it was used for peyronies.
I did a little research and I was very surprised to see that there were lots of positive reports:
http://www.cookmedical.com/uro/content/mmedia/UT8-53-06e.pdf
(over 100 patients)

but also negative (although this is only a 4 case report)
http://www.jurology.com/article/S0022-5347%2806%2901084-6/abstract

So please keep us updated about your evolution.

I really wish you all the best.


Luc

[mike67]

Thanks Luc for your kind wishes for continued success.
I have looked at your links and frankly prefer the Urology Times success story. You are right to point out the disparity but I have to trust in my doctor as this is his graft material of choice .
I am hopeful that my so far straightened penis will stay that way but can only hope and trust nothing drastic will happen later to disappoint me and my spouse.
I will certainly maintain this thread with my updates as time goes by.
Mike

[james1947]

First my best wishes also to Mike to continue with good progress. Thanks for the post detailed process. Do you get some medications that your body will not reject the SIS graft?
Regarding the report in Luciano link:

The team reported that 34
(79%) of 43 surgical procedures using the dermal
graft and 13 (80%) of 15 procedures using
the SIS graft were judged to be successful at a
mean followup of 18 months and 10 months,
respectively.

Total surgeries in this study are 56.
The main difference between the two material grafts is shortening the surgery time that is always good and not having a scar in the place of the dermal graft harvesting.
James

[mike67]

Thank you James for the best wishes.
No , he did not give me anything to take home for the SIS graft.
Mike

[0x5555]

Great to hear Mike - all my best for your recovery!

[mike67]

Thanks very much Ox5555