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Author Topic: Incision and grafting surgery Scheduled on 10/19/21  (Read 563 times)

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tencents

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Incision and grafting surgery Scheduled on 10/19/21
« on: October 15, 2021, 08:42:12 AM »

Hi all,
I will try and log my experience of incision and grafting surgery scheduled on 10/19/2021. I will be going to COVID test tomorrow at 1 EST. I live in Detroit suburbs and Surgery team consists of 3 Urologists from University of Michigan. Two of them are highly experienced and have done few hundred of various types of surgery for Peyronies. One Physician routinely does incision grafting at least one per week if not more. Right now I am stressed out about surgery and can think of anything other than that. As such I am suffering Anxiety Disorder and have been taking medications for that for last 20 years. Even those medication don't seem to be working right. I will keep posting under this thread my experience. Thank you for reading.
Logged
Age: 52 Peyronies onset: March/April 2019
Status: 45 Degree compound curvature, meaning its both sideways and upwards. Pain for couple months
Xiaflex one round with no effect. Had hematoma after last xiafelx shot
Surgery inc and Graft on 10/19

LWillisjr

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #1 on: October 15, 2021, 12:16:05 PM »

Will be very interested to know and track your results.
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Developed peyronies 2007 - 70 degree dorsal
Traction/MEDs/Injections/Surgery 2008
65y/o  13 years Peyronies free
My History

westerntown

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #2 on: November 06, 2021, 09:02:33 PM »

How did it go?
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20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe Erectile Dysfunction- floppy unstable erections that feel like water balloon .

tencents

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #3 on: January 04, 2022, 05:01:46 PM »

Hi,
It took me this long to think what do I write. It went well but it was a hell of a journey so far.
Will provide all the details in the next few days
Logged
Age: 52 Peyronies onset: March/April 2019
Status: 45 Degree compound curvature, meaning its both sideways and upwards. Pain for couple months
Xiaflex one round with no effect. Had hematoma after last xiafelx shot
Surgery inc and Graft on 10/19

tencents

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #4 on: January 04, 2022, 05:03:18 PM »

Here is my post surgery notes. I decide in the last minute to go with penile implant as well in addition to incision and grafting.

ROCEDURE PERFORMED:
1- Injection of the penis with vasoactive agent
2- incision and grafting to correct curvature 6 cm x 6 cm tutoplast graft
3- placement of Inflatable penile prosthesis placement. AMS 700 CX with inhibizone 18 cm +3cm Right, 2 cm Left, 100 ml conceal reservoir
 
PRIMARY ATTENDING: Bahaa Malaeb, MD
ASSISTING: Yooni Yi, MD
RESIDENT: Roberto Navarette, MD
 
INDICATIONS FOR PROCEDURE:patient is a 52 year old male patient with severe peyronie's disease and erectile dysfunction who was evaluated with penile doppler and offered various treatments and elected to proceed with penile incision and grafting in combination with penile implant. We discussed the surgery and potential complications including infection, scarring, loss of length and recurrent or residual curvature.
 
DETAILS OF THE PROCEDURE: The patient was met in preoperative holding. History and physical, and consent were confirmed. He was taken to the operating room, placed supine, and underwent induction of general anesthesia. He was placed in the frogleg position and his genitalia and abdomen were shaved, prepped, and draped sterilely.
A preoperative timeout was performed and preoperative antibiotics of gentamicin, vancomycin, and fluconazole were administered.
 
The procedure was started with injection of 60 mg of papaverine. The patient had a 60% erection.
We started with a ventral midline horizontal incision and taken that down to the level of the urethra. We then dissected laterally and bucks fascia was lifted off of the corpora just lateral to the urethra.
When the neurovascular bundle was completely mobilized, we were able to identify the full extent of the peyronies. We incised the corpora in a double Y horizontal fashion and trimmed the corners. We then measured the defect around 6 x 6 in its longest dimension. We then used a 6x6 cm tutoplast and sutured it to the defect after fashioning it into a butterfly shape with 5-0 pds.
We ensured hemostasis with bipolar cautery.
Bucks fascia was then closed with running 5-0 pds
 
We changed the superficial drape and placed a Foley catheter sterilely on the field and cleaned the Foley catheter with Betadine. A Lone Star self-retaining retractor was placed. We then extended our vertical midline incision to the penoscrotal area.The corpora were cleared off bilaterally to prepare for space for the corporotomies. The midline septum was dissected off the urethra in the midline. The scrotal fat was then entered bluntly and a space was developed at the posterior inferior aspect of the scrotum for placement of the prosthesis pump below the skin and dartos layers. We then made a 3 centimeter corporotomy on each corporal body as proximal as possible. We then performed serial dilation of the corporal bodies using Brooks dilators bilaterally up to a 13 mm, both proximally and distally. There was no evidence of a crossover or perforation. During dilation, there was no apparent injury to the urethra. The measurements of the corpora was 20 cm on the left and 21 cm on the right. The discrepancy was strictly proximal. We preplaced 2-0 Vicryl stitches to close the corporotomies.
 
We then sterilely prepared an 18 centimeter AMS 700 CX with inhibizone device with 2 and 3 centimeter rear tip extenders on the left and right, respectively. We then accessed the retropubic space through the penoscrotal incision in order for placement of the reservoir behind the pubic bone by elevating the external ring of the inguinal canal. Space was entered without difficulty and the reservoir was placed retropubically. We then filled the reservoir with 95 cc of saline and confirmed that it did not come out of appropriate positioning. We then placed the penile prosthesis in the predilated corporotomies. There was good fit of the device in the corpora. We then closed the preplaced sutures over the inflatable cylinders. We then used a straight quick connector to connect the pump to the reservoir to complete the circuit and maintain a vacuum seal. We then tested the inflatable erection and noted that the patient had good cosmetic and functional result with good rigidity and appropriate positioning in the glans without evidence of any perforation. There was no significant curvature. The prosthesis was then partially deflated and the pump was placed in the inferior posterior aspect of the scrotum under the skin and dartos in the most dependent spot. At that point, we irrigated copiously and confirmed hemostasis from the corporotomies, which was excellent. There was no other notable bleeding in the surgical bed. We then closed the subcutaneous tissue over the tubing with a running 4-0 Vicryl stitch and then we closed the dartos with a running 4-0 Vicryl stitch and closed the skin with a running 4-0 Vicryl horizontal mattress stitch and covered the incision with skin glue. The cylinder passing strings from the device were removed from the glans, and Dermabond was applied over the needle poke sites on the glans for hemostasis. The patient was cleaned and a Kerlix was wrapped around the penis and scrotum for a hemostatic compression dressing. A jockstrap, and a Foley catheter strap were applied and the Foley catheter was placed to drainage. The patient was awoken from anesthesia and taken to recovery in stable condition. He tolerated the procedure without apparent complication.
Logged
Age: 52 Peyronies onset: March/April 2019
Status: 45 Degree compound curvature, meaning its both sideways and upwards. Pain for couple months
Xiaflex one round with no effect. Had hematoma after last xiafelx shot
Surgery inc and Graft on 10/19

tencents

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #5 on: January 04, 2022, 05:18:03 PM »

My first tow days after surgery was as usual with lot of pain in line with a major surgery especially to a sensitive part. As the implant was partially inflated for the first two weeks I was in lot of pain. Pain was initially because of wound from surgery. However I had this burning sensation and lasted for good 12 weeks. I still have burning sensation in my glans. I had no complications of whatsoever like infection, improper sizing or anything for that matter. I did notice that there is this loss of length probably to the north of one inch. My surgeon tells me that it will be recovered as I go thru cycling of the implant. I am not terribly optimistic about that though. I have cycling regularly about  once a day for the last 6 weeks and limited  it because of the pain. Only from the last week I have increased the implant cycling to twice a day and will increase it to 3 times a day and hope that surgeon was right in regaining the lost length. I will try to post the pre and post surgical picture which may help some one considering the incision/grafting and implant. I did try to have intercourse but not very successful at that. This may also be due to my significant others hesitation as she has seen me the suffering I went thru after surgery. Hopefully we can over come this gradually. I will provide more info about my experience chronologically from the day of my surgery. I just have to recollect info which I have not forgotten yet. But I think surgery has been successful in that my penis is absolutely straight and also have gained some significant amount of girth. My decision to go for implant was very had as I knew there's no going back once you had this done.
Logged
Age: 52 Peyronies onset: March/April 2019
Status: 45 Degree compound curvature, meaning its both sideways and upwards. Pain for couple months
Xiaflex one round with no effect. Had hematoma after last xiafelx shot
Surgery inc and Graft on 10/19

westerntown

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Re: Incision and grafting surgery Scheduled on 10/19/21
« Reply #6 on: January 05, 2022, 02:51:57 AM »

Getting a penile implant is a pretty huge “last minute” decision. Glad everything worked out
Logged
20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe Erectile Dysfunction- floppy unstable erections that feel like water balloon .
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