Anyone had Extra Tunical Grafting to fix indentation?

[nemo]

Have just learned and read about Extra Tunical Grafting, to basically patch-over indentations and/or hinging effect. Supposedly much less risk of Erectile Dysfunction or other problems as tunica is not actually cut-into or modified.

I'm thinking that if my current indentation becomes worse (I'm still in the acute stage), if surgery becomes necessary, ETG might be a better alternative than penile implant, as I still get good erections. To date, I don't have any curvature, just a circumferential indentation that covers about half of my right corpora from the dorsal up the side. It clearly tracks a grain of rice lesion I can feel when flaccid.

Has anyone here actually had the surgery?  And who are the leading surgeons doing this procedure? I know Tom Lue wrote a paper on the procedure - is he considered the best at it?

Thanks,
nemo

[Mikel7]

I have not but I think in this video that Dr Levine addresses some of it. --->https://vimeo.com/189695340 .He
clearly shows the surgery so it is not for the faint of heart.

[cdub]

Dr Trost just put out a video a few days ago describing what ETG is and it is not PEG which is what Dr. Levine is doing/talking about in the link provided by Mikel7.

See my link:
https://www.youtube.com/watch?v=dmdi2s_L9Uw

[jj21]

I discussed it with my uro but he advised that if the indentation is towards th base the risk is much higher.

I'm interested in othr user experiences if there are any?

[Sonic]

I'm thinking about doing this procedure. I have narrowing on thr right side close to the base which causes a 20° curve to the right. Plication for a mild curve like that would probably be a bad choice for me. The narrowing causes some instability while erect which is my main issue and I've heard the graft placed in the area in this procedure helps fill in that narrowed part and make it more stable. I'm honestly still too freaked out about having someone cutting me open down there.. 

[nemo]

I understand your reservations, and it sounds like our condition is similar - my indentation is right side, causing mild wasting on the other side as well, and about a 15-degree slant to the right.

Keep us posted if you pursue this procedure. It makes sense from a structural standpoint.

nemo

[cdub]

I saw Dr. Levine a little over a week ago and I asked about ETG as I have a large indentation on the right side of my penis about 1/2 way up the shaft.  He specifically said without hesitation and repeated it to me that ETG will not provide added structural support to the penis.  Kind of took the wind out of my sails honestly.  Not sure if other Doctors/Surgeons share this belief as well?  Dr. Lue, Dr. Christine, Dr. Trost?  I'm still looking at getting second opinions from some of those mentioned. 

One of the things Dr. Trost brings up in the video I linked to earlier in this thread is that they still don't know whether or not the graft gets reabsorbed by the body or if it helps act as a scaffold for the body to fill in with the body's own tissue over time?  If the latter is the case, then my assumption is that the graft would provide structural support. 

[Sonic]

I saw Dr. Levine a little over a week ago and I asked about ETG as I have a large indentation on the right side of my penis about 1/2 way up the shaft.  He specifically said without hesitation and repeated it to me that ETG will not provide added structural support to the penis.  Kind of took the wind out of my sails honestly.  Not sure if other Doctors/Surgeons share this belief as well?  Dr. Lue, Dr. Christine, Dr. Trost?  I'm still looking at getting second opinions from some of those mentioned. 

If Dr. Levine is right then ETG is purely just a cosmetic procedure? If the graft does not provide support then what is the point of this entire procedure? I'm not well read when it comes to this area but theoreticaly speaking, if your penis has an indentation that does not fill in upon erection and that indent is filled in with a graft, isn't providing support exactly what it does?

Out of curiosity, what did Dr. Levine recommend you do against this indent?

[cdub]

If Dr. Levine is right, then the point is it's purely aesthetic and psychological, which to me are not necessarily bad things.  Looking down and seeing your penis with a huge indentation in it is off putting for sure, as this is something I'm dealing with.  It looks very different and feels quite a bit different in the hand, that being said my girlfriend claims she does not notice a difference which is a sweet thing to say, not sure if that is entirely true though.  I can't help but think that ETG will help provide some structural support though.  Maybe not much but it has to contribute some, especially if the theory that they have about the graft sitting in place and acting like a scaffold for new tissue to 'grow into'.  In my mind if that is the case, that new tissue 'fills in' that gap between the graft and the indentation then that will provide some structural support. 

I have still not consulted with other doctors yet over this.  I was reading Benjamin62's take on this as he had ETG done by Dr. Christine and Benjamin62 states that ETG does provide added structural support.  So, I wonder if that is Dr. Christine's take as well?  Perhaps we have some conflicting opinions on what ETG does within the medical community or maybe Benjamin62 mis-interpretated what Dr. Christine had to say on ETG as well when it comes to added structural support?

As far as my situation, Dr. Levine gave me a few options:
-Do nothing and move on with my life. 
-Get the ETG done even though it won't offer structural support (his words), it would be aesthetic and psychological reasons.
-Consider Excision and Grafting (this is very invasive for me at this point as I have good erections and my penis is straight)
-Consider Penuma, this is a penis girth transplant that is silicone (in theory it would 'cover' and address a lot of my issues)
-Continue with traction and hope that the indentation fills out eventually

I'm really not sure what I will do right now.  My condition is stable right now.  Penis is straight, erections are great, sex is good although I do have some pain afterwards sometimes if I'm not careful.  I'm taking a break until May to decide what I want to do for sure.  I will reach out to some of the other Drs in this field doing the ETG work to see their thoughts on whether ETG provides any support.  I'm thinking I will probably continue with traction by hand for a while and see if this helps anything and if not I will go the route of ETG for me.

[nemo]

I like the way you're thinking through this.

I think at this point, a consult with Dr. Christine would be helpful and informative. It sounds like he has more experience with this technique than anyone we hear of around here.

nemo

[Sonic]

I'm really not sure what I will do right now.  My condition is stable right now.  Penis is straight, erections are great, sex is good although I do have some pain afterwards sometimes if I'm not careful.  I'm taking a break until May to decide what I want to do for sure.  I will reach out to some of the other Drs in this field doing the ETG work to see their thoughts on whether ETG provides any support.  I'm thinking I will probably continue with traction by hand for a while and see if this helps anything and if not I will go the route of ETG for me.

My indent just like yours is located near the base on the right side of the shaft. It's caused a 20° curve and because the spot doesn't fill out properly also it's more wobbly and unstable while erect, prior to getting this crap it was pointing straight as an arrow and at the same time rock hard and very stable remaining in place. Those days are now just memories from the past with this condition.

It seems like indentations are generally very hard to treat and do not respond well to standard treatments like traction, ved etc. You say your penis is still completely straight when erect, this is a plus, you also say you have proper erections. How about instability? Is your penis more wobbly when you are fully erect or is it the same as before you got peyronies?

If you have straight erections, no instability when erect then I would very strongly recommend against even thinking about excision and grafting. This is a complicated procedure reserved for people with very high degrees of curvature and you also risk Erectile Dysfunction this should not even be considered based on how you have described your penis.

Only logical surgical treatment for you is honestly ETG. Also on a final note, be careful with the traction by hand as traction is pretty much a complete waste of time when it comes to large indentations anyway, unless your lucky. Do it if you wish and carry on doing what works for you but just remember you are risking making the condition worse.

[jj21]

Sonic - appreciate your post and advice but just like to add that for some people VED and restoreX has helped with indentations.

Please don't think I am being rude.

I also have serious indentations and would love to know more about ETG

JJ

[Sonic]

Sonic - appreciate your post and advice but just like to add that for some people VED and restoreX has helped with indentations.

Please don't think I am being rude.

I also have serious indentations and would love to know more about ETG

JJ

That's true but from all I have read online those seem to be a lucky minority. Most guys dents never go away.

[Bud luck]

I tried traction to correct my dent and narrowing and I made it worse, now my penis also slightly rotates. The most depressing is the fact that no one in the world knows what to do to correct the problem.

[Sonic]

I tried traction to correct my dent and narrowing and I made it worse, now my penis also slightly rotates. The most depressing is the fact that no one in the world knows what to do to correct the problem.

Sadly this happens to many men and you and me are two of them. I also did traction by hand and also tried out a device and though I do not have before and after pictures to compare I can swear I'm certain it made mine worse. At first it was only a narrowing close to the right side of the base, now it runs up almost to half of the shaft. The biggest problem with this disease is almost no man knows this condition even exists until you get it yourself and find it by googling.

Had I known this was a thing I would have been a lot more careful in the past. Most men do know that you can fracture your penis but not that a condition exists where scar tissue is formed and causes all sorts of problems like severe curvature, bottle neck deformities, narrowing and pain.

Also it does not help that the knowledge worldwide by urologists in regards to this disease is limited and from the ones who specialize in the subject there is very little they can do apart from surgery. Sure many men have had great results from traction and other tools, I'm happy for them, but most men seem to get nowhere. It's a disease that causes a great amount of mental health issues.

The worst part is everyones peyronies is completely different, some even heal spontaneous while others even perform drastic surgery like plication and shortly after get reinjured and get new deformities. For a very large amount of men it's pretty much like this, once you get it it's kinda game over because for one the penis has already taken damage and will never be the same on the other hand that pshycoligal aspect and fear of reinjuring yourself always lingers in the mind.

Even with surgery there is always a risk of reinjuring yourself because the condition is hereditary we who get it simply have an aspect to us where some bizzarre process happens with collagen and whatnot. If you think about it you've probably seen many in the adult industry who go at it super hard and even bend their penis severely during scenes but nothing ever happens to them whereas some other guy might just slightly twist his penis once during sex and gets peyronies.

[jj21]

Sorry you guys are going through this man... VED was helping with my indentations but I've had to take a break for a while.

You're right thoufh - what works for one of us may not work for the other.

[jj21]

Have a look at my improvement post in the improvement forum - I definitely regained girth n cured some indentations. I know every situation is different but I definitely recommend trying it - just very cautiously. Also remember an implant is also a last option.

[Sonic]

Sorry you guys are going through this man... VED was helping with my indentations but I've had to take a break for a while.

You're right thoufh - what works for one of us may not work for the other.

Seems like the main thing with VED's are that overpumping can happen extremely easy if one is not cautious enough. I think this is why there are many accounts of improvement from them, but also a massive amount of horror stories. I've even read there are some urologists worldwide who refrain from even offering this as a treatment because of the high risk of reinjuries.

On the other hand it seems to have helped some users greatly.

[cdub]

It seems like indentations are generally very hard to treat and do not respond well to standard treatments like traction, ved etc. You say your penis is still completely straight when erect, this is a plus, you also say you have proper erections. How about instability? Is your penis more wobbly when you are fully erect or is it the same as before you got peyronies?

If you have straight erections, no instability when erect then I would very strongly recommend against even thinking about excision and grafting. This is a complicated procedure reserved for people with very high degrees of curvature and you also risk Erectile Dysfunction this should not even be considered based on how you have described your penis.

Only logical surgical treatment for you is honestly ETG. Also on a final note, be careful with the traction by hand as traction is pretty much a complete waste of time when it comes to large indentations anyway, unless your lucky. Do it if you wish and carry on doing what works for you but just remember you are risking making the condition worse.

It seems my erections are stable, so not much of a change before peyronies.  I'm mainly concerned about potential reinjury as I think an indentation in the long run can really hurt instability, especially when my erections are not as full.

Yeah the Excision & Grafting procedure I thought was really far out there as being a current possible procedure for me.  It's very invasive and I'm really afraid it would cause so many more issues like erectile dysfunction and pain!  Things that I don't seem to be having much of an issue with.  It would be like stirring up the hornet's nest. 

Point taken on the traction and traction by hand.  Still treading slowly with that and contemplating revisiting Restorex but never maxing out the force/pull on that thing as I think the traction on that is too strong. 

[Shane43]

I had never heard of the "Penuma" that Dr. Levine mentioned (even though he is also my doctor). I wonder if a short cock sleeve (external) can provide stability to hourglass cock? My indentations are pretty close to the base and cause instability. Xiaflex has helped, but I still have to be very careful with positions etc. Has anyone tried this to increase stability over the "hinge"?

[cdub]

@Shane43

I don't think Dr. Levine was mentioning the Penuma to be possible source of stability for me, sorry if I mislead there.  I think he offered it up as a potential option for me mainly for cosmetic reasons to address my large indentation on my right side of my penis and the slight wasting on the left side of my penis.  Dr. Levine does not think my indentation causes any instability, but I disagree.  The Penuma just sounds too good to be true and I've read some horror stories about it on other websites.

[Shane43]

@cdub - thanks for the clarification. Yeah, the Penuma surgery looks scary, is expensive and probably is mostly cosmetic.

[Sonic]

I saw Dr. Levine a little over a week ago and I asked about ETG as I have a large indentation on the right side of my penis about 1/2 way up the shaft.  He specifically said without hesitation and repeated it to me that ETG will not provide added structural support to the penis.  Kind of took the wind out of my sails honestly.  Not sure if other Doctors/Surgeons share this belief as well?  Dr. Lue, Dr. Christine, Dr. Trost?  I'm still looking at getting second opinions from some of those mentioned. 

One of the things Dr. Trost brings up in the video I linked to earlier in this thread is that they still don't know whether or not the graft gets reabsorbed by the body or if it helps act as a scaffold for the body to fill in with the body's own tissue over time?  If the latter is the case, then my assumption is that the graft would provide structural support.

Just bumping this since I came back from my uro a couple hours ago and it seems he's in line with what Dr Levine said. As for now he said he'll only operate on me if the condition gets much worse and just like you @cdub he said the best future option in that case would be excision and grafting. Not fun hearing that.

He did also make it clear that indentations are a big problem for men with the disease as it causes an array of different problems. The odd thing is after very carefully palpating the penis he said he could feel no plaque at all so I'm very confused how one could get a rather large indent like myself without any palpable plaque. Entire point of excision and grafting is to extract the plaque making the penis straight while at the same time filling in the dent with a graft restoring the girth so after being unable to feel any plaque at all he said that might be an indication I should refrain from surgery.

[gobbler]

Sonic, it is interesting to hear your report from those doctors. I too was of the impression after hearing in particular from Dr Trost and Dr Lue that extra tunica grafting was something to be excited about, something innovative which is actually atypical for peyronies research because not much progress and interest in progress has been there over the past years. However I also could not really get in line with the science of it, the reabsorption thing as well. there also does not seem to be much long term patient data and report on it.

indentations are indeed the worst in my opinion. I too have an indentation right below the glans and it is very irritating because I have less stability there and the worst for me is that it tears into the tissue and that causes significant discomfort and at times even pain.

my doctor also could not palpate anything and ultrasound in flaccid state also revealed no obvious plaque. my doctor suspects, that there is some scar tissue in the penile septum, the part of the tunica albuginea that is between the two erectile chambers. often times plaques there cannot be detected and due to inaccessibility they can also not be cut out or treated with injections.

I am also very confused how in my doctors terms "a small septal scar" can cause a significant indentation and loss of girth and so much discomfort.
like you my doctor also strongly advised against surgery because as you said if there is no obvious plaque, what are you going to cut through? also he suggested at my age in mid 20ties the risk for vascular Erectile Dysfunction post surgery is too high to attempt this even.

he prescribed me a VED so I can pump up and lose up the tissue. I have been using it for many months now with zero success. other doctors like Dr Trost also advice against the VED, suggest it can cause Erectile Dysfunction too. they also say that there is nothing you can do against hourglass deformities and indentations.

so to me this sounds like nothing at all can be done to improve the overall situation despite acceptance therapy and in my case total abstinence from anything sexual because its really uncomfortable to engage even in masturbation especially without lube

hope you find a solution

[Sonic]

@gobbler Thanks for that informative post. Seems like we are almost in the same boat only difference is the location of our indentations. When reading of ETG I first kinda felt like it would be my last hope in an attempt of fixing this problem but sadly it seems that is not the case. Out of all the guys with indentations I've talked to on forums only a handful responded well to standard treatments like traction and VED's while on the other hand a crap load of people got worse.

I wish you luck, surgery down there is something many men want to avoid at all cost and it really sucks that both of us are in our 20's talking about how nothing else can fix this issue except penile surgery. Only thing we can do is to find a way to live with it because the pshycologial aspect only worsens the damn condition. Have a good weekend.

[gobbler]

for me its the pain as well. this seems to be kind of uncommon for someone who is definitely not in the active stage anymore having seen no progression in many months but the pain is not subsiding. it is definitely not an inflammatory pain like I know from the active phase, the pain is simply from the indentation site which does not expand and upon a strong erections cuts into the flesh/erectile tissue causing the discomfort. it is like when you have not stretched a tendon in decades and suddenly it is severely shortened. this stretching pain makes having an erection highly unpleasurable and I think I developed erectile dysfunction as a result(only with manual stimulation can I achieve erections and cant hold them without either). it feels like the penis cannot expand properly because the constriction is holding it back.

I will give myself time but honestly, if I see no major (and I truly mean major because this is very upsetting to me) change in the next 3-4 years then I will look into getting an implant. I fear that since the deformity is right below the glans however, this might cause issues with the tubes as well. also of course not really keen on this solution at all. however I think it would fix box, the stretching pain during erection and the indentation and loss of volume. I also have a rotation in this area and this would also get fixed. but I really dont like the idea of pumping up my penis.

the only thing that gives me positivity here is that I had a pervious cause further down the penile shaft with an indentation and while not completely healing it has filling in over the past 2 years. I think getting regular erections is important due to "internal stretching" of the tissue which could make it lose up over time. in fact, I heard some doctor say that for some guys indentations get better over a longer period of time, 4-5 years, just by getting good and regular erections.
thats why my doctor has suggested I take 5mg Cialis everyday as a therapy not just for Erectile Dysfunction but also for regeneration even though there is little data on it, it makes sense that if external stretching and counter bending works for curvature, pressure from the penis internally could work against indentations but no clue really if it actually does.

I wish you a good weekend too

[Sonic]

@gobbler The thing with your pain definitely sounds very unusual and I feel for you pal luckily I don't have any pain at all in the area but I do share the feeling that when fully erect it sometimes feels really uncomfortable. I guess thats kinda normal though since our penises are full of scar tissue and they will never feel the same naturally again. Last part of your post is interesting. You've had a previous indent that has healed on its own naturally albeit not fully but more filled in as you say. That does indeed sound encouraging at least.

My uro also prescribed long time ago daily 5mg Cialis. I also take 1500mg Citruline and 1000mg L arginine every day. I feel like good blood flow to the region is absolutely crucial. I feel like every single day I mess my diet up just a bit the condition gets worse and the penis starts constsantly turtling and feeling stiff. I think there was a small study that showed daily 5mg Cialis proved to help the people in the test group with improving septal scarring. Although as you said, very little data on it.

[cdub]

I had seen Dr. Brian Christine last December concerning this procedure.  I forgot to update this thread with his response.  I had only updated on my Diary thread.  Below was Dr. Christine's take on ETG:

Extra Tunical Grafting.  He talked about this before to me in September. He said it really does not provide structural support, it's more of an aesthetic procedure and for looks.  If the look of the indent bothers me so much I might want to consider this.  The risk is, and these are his words, that most guys have about a 20% chance of erectile dysfunction after an ETG procedure, meaning they need cialis or viagra for sex.  With my current situation (straight and regular erections) I don't think that risk is worth it.

[Sonic]

I have also spoken to a surgeon about this. He said basically the same as cdub. I have come to the conclusion that if you have even the slightest Erectile Dysfunction combined with your Peyronies then an implant is the only surgery worth doing. Every surgery provides a risk. If you have Erectile Dysfunction and do any standard Peyronies surgery as plication PEG etc then you will only end up with more scarring and possibly worse Erectile Dysfunction. I'd personally rather take the gamble with an implant then.

Really bad situation to have Erectile Dysfunction combined with Peyronies.

[Benjamin62]

Have just learned and read about Extra Tunical Grafting, to basically patch-over indentations and/or hinging effect. Supposedly much less risk of Erectile Dysfunction or other problems as tunica is not actually cut-into or modified.

I'm thinking that if my current indentation becomes worse (I'm still in the acute stage), if surgery becomes necessary, ETG might be a better alternative than penile implant, as I still get good erections. To date, I don't have any curvature, just a circumferential indentation that covers about half of my right corpora from the dorsal up the side. It clearly tracks a grain of rice lesion I can feel when flaccid.

Has anyone here actually had the surgery?  And who are the leading surgeons doing this procedure? I know Tom Lue wrote a paper on the procedure - is he considered the best at it?

Thanks,
nemo

Yes I had in done at the same time as my Plication with Dr Brian Christine in Alabama.  He learned it from Dr Lue.   I flew down from Boston for the surgery Feb 2020.   Most surgeons haven't done it or claim it doesn't work.   It does.   If I had the same condition id do it in a heartbeat.   Don't listen to naysayers.   Talk to the Christine directly

[Pfract]

Hey Benjamin! thank you for sharing your account with Dr. Brian Christine! Did you experience any Erectile Dysfunction after the procedure or any other adverse thing?

[ad3333]

Yes I had in done at the same time as my Plication with Dr Brian Christine in Alabama.  He learned it from Dr Lue.  I flew down from Boston for the surgery Feb 2020.  Most surgeons haven't done it or claim it doesn't work.  It does.  If I had the same condition id do it in a heartbeat.  Don't listen to naysayers.  Talk to the Christine directly

Hi Benjamin - I'm considering having the ETG procedure with Dr.Trost, can you give some insight to the scarring? Thanks for sharing your experience!