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Author Topic: A few questions about plication...  (Read 228 times)

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HeadsUp

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A few questions about plication...
« on: November 01, 2022, 11:04:31 PM »

I'm almost a year into my Peyronie's journey.  After being diagnosed I started Pentox and Vitamin E... didn't help.  I purchased both a RestoreX and a cheap vacuum pump, using them on occasion but not daily (as I should).  I've started back up, we'll see what happens.

My condition seems to have stabilized (knock on wood - no pun intended), and I'm starting to look more seriously at other treatments.  One that keeps coming to mind is plication surgery.  I've read quite a bit about it on the forum, but still have a few questions:

- am I a candidate, if I have a 60-70 degree upward bend?
- is any of the scar tissue removed?
- does it leave a scar on the bottom of the penis?  If so, is it uncomfortable?
- are the sutures left inside the penis?  If so, are these uncomfortable?
- do people typically lose around an inch of length?

If I was told my penis would be .5" to .75" shorter but almost straight (with no lingering discomfort) after plication, I'd sign up for it tomorrow.  Am I missing something?

Thanks for answering questions that I'm sure have been asked many times before!

EDIT:  I should probably mention there is no hourglassing or additional bends... just an upward bend about 2"-3" from the tip
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62 Years Old
Peyronie's onset: Jan/Feb 2022; Diagnosed June 2022
Main symptom: upward curve (plaque on top), unsure of degrees (probably between 45-75 degrees)
Initial treatment: Pentox 400 mg, 3x/day - NO LONGER, NOW RESTORIX

john.doe.550

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Re: A few questions about plication...
« Reply #1 on: November 02, 2022, 12:40:22 AM »

Hello Headsup,
unfortunately, I'm qualified to provide answers to some of your questions.

#1 matter: assure you are through the initial (and often painful) phase with assured stabilization before heading to surgery.  I waited two years prior to scheduling plication surgery to assure conditions were stable.  One minor benefit, aided in part by daily modeling (physical therapy), is minor but noticeable plaque reduction. It wasn't so difficult to put the surgery off because peyronies is not life threatening. 

With a talented surgeon, yes you are a candidate with 60 to 70 degree upward bend.  One of our forum members was like me. He was 90 degrees and his plication surgery produced enviable results.  My upward bend is even greater than 90 degrees and I'm anticipating a very good result from plication scheduled at November's end.

The surgeon that will perform plication informed me that scar tissue is not removed.  Specifically, he said, " the scar tissue will be in you following the surgery. It's not like the plaque sits on top and outside the elastic tissue. It's actually tissue that changed texture."  He went onto say that if removed, then: 1) a hole is made in a unique elastic tissue is cut that won't stretch as originally intended if stitched and for which there is not an attractive substitute.  Some surgeons will remove some plaque and this requires replacement filler material within the penis and exterior tissue patch material that is not as elastic as it needs to be.     

Scars are fine to very fine. They may / may not fade to visual perception.  No one I know that completed plication indicate long term discomfort related to scars.

Many surgeons use dissolvable sutures.  A smaller number do not. Yes, non-dissolvable will remain inside you. They're not removed.  Some patients reported being able to feel non-dissolvable sutures.  Most patients say non-dissolvable sutures is not uncomfortable.  However, a few report one or two sutures are routinely annoying.  I'm going with absorbable sutures.   

There are posts in our forum about length loss.  Reported length loss ranges from 1/4 inch to 1 inch. Loss or lack of loss is based on many factors.  One of the major factors relates to exactly how the surgeon performs the plication. There's some variation in plication application.  Another major factor is whether the penis is straight or not.  One benefit by waiting for two years and continuing to model is a minor increase in length despite what the plaque originally took from me. I anticipate coming out pretty close to my original length when plication is completed.  Two additional notes to share: 1) If you want to have good sex again without concern for additional damage caused by bend, then some loss is okay (this is echoed by someone I trust that completed plication and enjoys sex as much as i do), and 2) My surgeon said, "Don't worry about that."
 
You shared that "If I was told my penis would be .5" to .75" shorter but almost straight (with no lingering discomfort) after plication, I'd sign up for it tomorrow.  Am I missing something?"  No, you are not missing something. Of course, any surgery with general anesthesia carries risks.  These potentials were on my mind for quite awhile.  Now that there's been no sex for more than 2 years and the urge remains strong, I am ready to accept these risks.  Losing length concerned me, too.  Again, after no sex and no decrease in sex drive, I'll accept losing a little bit of length.  Simply, I encourage you to assure you're condition was stable long enough. 

You shared that "there is no hour glassing or additional bends... just an upward bend about 2"-3" from the tip."  Like you, I have no hour glassing and am quite straight left to right.  The difference between our morphologies is my curve is a like a backward capital letter "C" beginning at pubic area abdomen with head touching abdomen near navel.  My surgeon anticipates a very good result with plication (and I trust him). 
 
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Age: 63;  Peyronies Disease diagnoses: MAR 2019;  Onset: Immediate & severe;  Treatment: Xiaflex, APR 2019 to early 2021, slow & steady improvement w/ notable Xiaflex improvement through 2021. Incisional corporoplasty scheduled for late 2022.

john.doe.550

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Re: A few questions about plication...
« Reply #2 on: November 02, 2022, 01:20:14 AM »

Headsup, here is a very informative video by Dr. Landon Trost: https://www.youtube.com/watch?v=14bSlbsQN0A&ab_channel=MaleFertilityandPeyronie%27sClinic

In this video, Dr. Trust discusses plication and coroplasty. They are very similar.  For clarification, my planned surgery will be coroplasty. 
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Age: 63;  Peyronies Disease diagnoses: MAR 2019;  Onset: Immediate & severe;  Treatment: Xiaflex, APR 2019 to early 2021, slow & steady improvement w/ notable Xiaflex improvement through 2021. Incisional corporoplasty scheduled for late 2022.

LWillisjr

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Re: A few questions about plication...
« Reply #3 on: November 02, 2022, 08:54:25 AM »

The exact technique will be determined by your surgeon. And I can only encourage you to find one who specializes in Peyronies treatment. You want to find a surgeon who does these many times a year versus a few times a year.

I had a 70 degree plus curve and my surgeon said plication would improve me maybe 45 degrees. Meaning I would still have a 30 degree curve. So he opted for "excision and grafting". Just saying this is another option to consider. My surgery was nearly 15 years ago and I am still happy with it. I am sure there have been many advances in surgical procedures since then.
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Developed peyronies 2007 - 70 degree dorsal
Traction/MEDs/Injections/Surgery 2008
66y/o  14 years Peyronies free
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Muttley

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Re: A few questions about plication...
« Reply #4 on: November 03, 2022, 02:54:11 PM »

We are talking about the basic Nesbit plication procedure here are we? It would be good to be clear about that.
Also, if it is Nesbit, how do dissolvable sutures maintain a straight erection? I thought that the sutures played a critical role in keeping everything straight. If they dissolve, isn't that compromised?
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Late 50s
Official diagnosis 12/2021
Bend at the end @70 degrees upwards/@20 left
RestoreX twice daily
Daily Supps: L-Citrulline, Pycnogenol, Cialis 5mg daily, Mg and Cu

HeadsUp

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Re: A few questions about plication...
« Reply #5 on: November 09, 2022, 05:23:08 PM »

Thanks everyone for your replies!  I really appreciate it.  Since its occurrence, it's difficult not to think about this many times each day. 

I will wait until I'm sure it's stable (I think 12-18 months is a rule of thumb?).  Plication seems to have many upsides and few downsides.  I don't look forward to surgery, but I'm looking forward to being "pretty much normal" again.

In the meantime I'll continue to use RestoreX and the vacuum pump (and continue to read others progress here on the forum).

Thanks again!
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62 Years Old
Peyronie's onset: Jan/Feb 2022; Diagnosed June 2022
Main symptom: upward curve (plaque on top), unsure of degrees (probably between 45-75 degrees)
Initial treatment: Pentox 400 mg, 3x/day - NO LONGER, NOW RESTORIX
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