My Peyronie's surgery diary (modified Nesbit)

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MiddleAgedMan

So I finally had my surgery and thought I'd share my experiences with the forum, hopefully this will turn out to be a success story.

Brief background: diagnosed in March 2019, with just a small lump on the ventrolateral side and a bit of hourglassing but didn't affect sex in any way. Tried various oral medications (vitamin E, coenzyme Q10, frequent use of Viagra) but had no effect. Got much worse quickly in the latter half of 2019, developed a dorsal curve eventually about 70 deg, hourglassing diminished though. Used traction (PMP) but got scarring of the glans, then VED (Soma) but no change. Sex was still possible but uncomfortable for wife and not as enjoyable.

So a year ago I decided to go for surgery as last resort. Initially wanted to go down the incision and grafting route but after meeting with consultant and considering the risks I held off making a decision until September, when I instead went for the plication/Nesbit route, as the risks of Erectile Dysfunction and sensation loss are much lower, and I am not too bothered about the length loss (which had mostly happened already on the affected side anyway). I was expecting to have the surgery in a year's time (NHS waiting lists) but was lucky to get a last minute cancellation time slot yesterday.

After a pre-assessment to take blood tests and medical history last Friday, I went to the hospital yesterday for the procedure. I arrived early in the morning but had to wait until early afternoon for the actual surgery. Before I got to meet with the surgeon and the anaesthesiologist who went through the procedure in detail and answered my questions well. I had thought they would do a dot plication using multiple permanent sutures but the surgeon said he doesn't use those as if the sutures break the operation will have to be redone. Instead, they use a variation of the Nesbit called Yachia, which involved cutting short longitudinal slits along the shaft of the penis opposite the point of curvature, and then pulling the slits transversely so that when they are sutured (with slowly absorbable sutures) they cause a shortening to match that on the affectd side of the penis. Several studies - which I've read - have found this procedure to have high success rates and fewer complications than the regular Nesbit (which involves cutting out a small part of the tissue to effect the shortening) and also compares favourably with the dot plication procedures. I also opted for a longitudinal incision rather than degloving (again shown to have better results and quicker healing) and not to undergo a circumcision as this can result in sensory loss. The surgeon was very happy to make these modifications which he had clearly done previously (he is one of the UK's most experienced surgeons of Peyronie's, particularly with the Nesbit-type plications and advised against the Lue (grafting) option unless the curvature was so severe that it was the only option). I expect to lose up to an inch in length, but am not bothered about that; a curve is much more problematic and my wife was not concerned at all about me becoming a little shorter (I had about 6.5" to start with so sufficiently long to begin with). I might have made a different decision if I were younger and single, though.

Surgery went well, I was in the theatre for about an hour and came to soon after. My only annoyance was that I only got to see the surgeon while I was still recovering from the general anaesthesia so wasn't clear enough in my head to ask all the questions I wanted, but will be seeing him in 6 weeks time for a checkup and can call him for a telephone query in the meantime.

My penis was bandaged up like a hot dog, the glans is looking fine with just a small hole from the needle used to inject saline (to indue erections) but isn't sore, and I have a bruise at the base where they presumably put a ligature for the erections. Pain has been minimal, once the local pain block they placed after surgery wore off I felt at most mild discomfort and although I got strong pain killers I didn't need them. In fact I felt so well after the procedure that I decided to travel home by train rather than taxi (my wife would have picked me up but she doesn't drive...). Slept fitfully but not due to pain as much as too much caffeine... No issues passing urine (I guess they didn't need to use a catheter) so so far so good. Apparently I am advised to remove the dressing today, which seems a bit early but will check with the nurse before I do so, I might wait until tomorrow to take it off as I don't want to risk the scar to become infected. But I must admit I'm quite curious to see what it looks like - I expect it will be quite mangled at the moment! This morning I took two paracetamol (acetaminophen in the US) but mainly because I've just come down with a sore throat (unrelated to the surgery) but don't really need pain relief. I did once feel a sharp sting for a second, probably from one of the sutures but it hasn't happened again. I did have some minor discomfort from nocturnal erections, as my surgeon said I would, but mostly concerned about the erection causing the surgical wound to open up rather than any actual pain.

All in all, the procedure went without a hitch and I look forward to seeing how it will be once it heals. I will post before and after photos and of my ongoing progress later.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

MiddleAgedMan

Day 1 update: As instructed, I removed the dressing and it didn't look too bad at all. The penis is obviously quite bruised, mainly at the base (where they would have applied the tourniquet) and close to the glans, but the scar isn't too bad and doesn't show any signs of excessive redness or bruising. I put a new dressing on as there was a tiny amount of bleeding from removing the innermost layer of gauze, but that's to be expected. I don't think I'm ready to remove the dressing entirely just yet (although I was told that would be fine from today). Very mild dull pain or rather it feels sore, as one might expect. No way of telling from looking at my penis in its current state whether I've lost any length, I can't wait for it to heal enough that I can see if the op was successful.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Muttley

Hi MiddleAgedMan, thanks for the detailed update. Really pleased to hear that you are happy with the experience and tht it went well. Normal life beckons, you must be so pleased. Please do keep us posted!
Late 50s
Nesbit Procedure July 2023 which was successful
Official diagnosis 12/2021: Bend at the end @70 degrees upwards/@35 left

MiddleAgedMan

Day 3 update: Everything going well so far. No major changes to the penis, the bruising hasn't worsened or improved really, but the stitches look neat and there isn't much swelling or any sign of inflammation. No real pain, just occasional discomfort, getting out of a sofa can put strain on the penis for some odd reason but generally the most noticeable change is that (as I'm uncircumcised) it feels a bit uncomfortable having the glans exposed all the time (I wasn't circumcised during the procedure but want to leave the foreskin retracted until the wound has healed). Nocturnal erections are a bit uncomfortable, but not exactly painful and luckily subside quickly. I did notice however this morning that when erect the penis is nearly straight, and the length loss wasn't noticeable, so seems to have worked! Still wearing a dressing but will probably try to go without from today onwards (the doctor said I could remove it 24h after the op, I put on a fresh dressing as there was some minor bleeding at first but seems to have healed now).
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

MiddleAgedMan

Day 5 update: Slow but gradual improvement. Took off the dressing two days ago, wound seems to be healing fine, no evidence of infection or inflammation. Swelling increased after removing the dressing and with it slightly increased discomfort, especially after walking around - lying down is fine. However, no need for pain killers so really just a minor discomfort than actual pain. Nocturnal erections not quite as painful as at first but still uncomfortable and always slightly worrying that the sutures might not hold, but apparently it's normal and not a cause for concern to have erections at this stage. The upshot is that when erect it does look pretty good - so far the surgery seems to have achieved exactly what I hoped for! Just a bit impatient that the healing process takes so long but all in all I'm very satisfied.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

beaulieu1008

Does one know right after the plication how succesfull the surgery was? Can they tell?
60 years old. Peyronie disease since 2020. Upward curve 30 degrees. Thick calcified plaque, dorsal, just beneath glans. 2cm wide, 1cm long. No ED. Except soft glans.

MiddleAgedMan

Quote from: beaulieu1008 on December 12, 2022, 02:29:53 PM
Does one know right after the plication how succesfull the surgery was? Can they tell?
The surgeon will check that the erection is straight but I don't think you'll know for certain what the outcome will be until it has healed, and of course there's always the risk that it gets worse again. That said, my nocturnal erections have been sufficient to show that the bend is nearly gone, so it's looking good.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

beaulieu1008

I also meant in terms of risks. Like (partial) impotency.
60 years old. Peyronie disease since 2020. Upward curve 30 degrees. Thick calcified plaque, dorsal, just beneath glans. 2cm wide, 1cm long. No ED. Except soft glans.

user198501

I'm also wondering this. Can it take several weeks or months for full erectile function to return?
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MiddleAgedMan

The risk of worsening erectile function is small with this type of surgery, but for what it's worth my nighttime erections have been every bit as hard as before. So much so that it's a problem as it gets painful and wakes me up plus I can't help being a little concerned it might cause the sutures to tear, though the doctors tell you such fears are unfounded.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

MiddleAgedMan

Day 12 update: The healing is progressing fairly well - most of the incision is fully healed, but the lower end towards the base of the penis is still bleeding or weeping a bit, and there might be some minor infection (there was pus coming out of it yesterday, later that led to more bleeding presumably as the wound opened up a bit, and now it seems to be improving a bit). I've tried to get in touch with the urologist who treated me but they haven't called back yet, although the nurse I spoke to didn't seem to think it was a concern (there's no extended area of redness or pain indicating a serious infection). Most likely it is due to the foreskin rubbing against the sutures at that location, causing chafing and preventing it from healing properly. I'm using a dressing to keep the foreskin in place and prevent the chafing which seems to work. Anyone else had similar issues with healing?

Other than that, things are much improved. I get strong nocturnal erections and they don't hurt although can be slightly uncomfortable around the internal stitches at the glans end of the penis where there's the most sensation; the two pairs of stitches closer to the base are barely noticable. There is a little occasional discomfort but no pain. Oddly, I don't get erections in the daytime easily but since I get good nocturnal ones I'm not worried about erectile dysfunction. Although objectively my penis is now shorter - my attempt at measuring suggests it's a little over 5" compared to around 6.5" before Peyronies - it doesn't feel shorter, if anything a little thicker (probably just a visual illusion). The glans and the small part of the shaft in front of the stitches might be a little less hard when erect, and bends slightly to the left (previously I had a more marked congenital bend to the right which I assumed the doctor tried to fix), but otherwise it is pretty straight, probably no more than 20 degrees upward curvature and feels like less. Provided the erectile issues turn out to be just temporary and due to my actively trying to avoid sexual excitement, I am very happy with the result. I am looking forward to the healing being complete and the stitches dissolving so I can roll back the foreskin over my glans, as having it exposed all the time is the most difficult sensation to adjust to (I'm very glad I didn't go for circumcision!). I dont want to try to do that until the scar has healed a little better though, probably toward the end of this week I'll give it a try.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

MiddleAgedMan

So it's now day 17 and it's mostly all good so far. I met with a nurse three days ago and she  cut off the ends of the sutures sticking out of the skin, and that seems to have helped with the chafing issue that caused the bottom part of the incision to bleed and be painful. It is now almost completely healed, although the bit that was chafing is still a little tender and occasionally bleeds very minor amounts around what seems to be a suture protruding ever so slightly from the scar. It isn't red or swollen though so no infection, but likely just the suture irritating the surrounding tissue and at the rate it's healing I expect it to be fully healed within a week. The rest of the scar is completely healed and just looks a bit bunched up, it is slightly tender to the touch but not very much. I get strong nocturnal erections and occasional daytime ones, and it looks almost perfectly straight so the surgery has definitely been a success. The one negative issue is that the end of the scar that has been slow to heal seems to have become attached to the underlying tissue rather than sliding freely like foreskin normally does. This means I can't move my foreskin back over the glans which is a major concern. The nurse I spoke to didn't seem to think this was a matter of urgent concern, so I'm either hopeful that the issue will resolve by itself until I meet with the surgeon in four weeks' time, or if not that it will be a relatively straightforward procedure to make a small incision and separate the foreskin from the underlying tissue. In the meantime, it doesn't seem like it will affect sexual function and I can somewhat awkwardly pull the dorsal part of the foreskin over my glans to keep it covered so it doesn't keratinize and lose sensitivity. So, it's a concern and an irritation, but to be fair my surgeon did say that individuals who had phimosis (I had surgery for it as a child) often have complications if the foreskin isn't removed. I'm just hoping whatever corrective surgery might be needed won't have to wait for months and months (and ideally won't force me to abstain for another six weeks...). Interestingly the sutures under the skin - the ones correcting the curvature - can clearly be felt but aren't uncomfortable at all, only slightly tender toward the tip of the penis where there's the most sensation. So even though those scars will remain once the sutures have dissolved I am confident they won't be an issue at all, which was a concern of mine before the surgery.

Would love to hear from anyone who has had a similar issue with the foreskin attaching to the underlying tissue in this way, and how it was resolved.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Alex83

Hey
I had my surgery 3 days after you, you seem to be healing well! Were your foreskin sutures supposed to dissolve on their own or did you have to cut them?
Did your surgeon tell you how long you should keep them? Do you still have them?

Good recovery!
27 yo

- 01/2020: Nesbit surgery for a 50 degrees downward curvature with Dr.Faix (FR) : bad result

- 12/2022 : Surgery correction with Dr.Gelman US

- Now : Indentation on the left dorsal side with a rotation to the left that appeared, try Restorex

MiddleAgedMan

Quote from: Alex83 on December 24, 2022, 09:23:12 PM
Hey
I had my surgery 3 days after you, you seem to be healing well! Were your foreskin sutures supposed to dissolve on their own or did you have to cut them?
Did your surgeon tell you how long you should keep them? Do you still have them?

Good recovery!

Hi they are dissolvable sutures so don't need to be taken out, but bits and pieces of them keep falling out of the wound as they dissolve deeper in the tissue - it's easy enough to remove them carefully with a pair of clean tweezers. I found that the ends sticking out of the skin were chafing a bit so my nurse cut off those ends.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Alex83

Oh right! How long does it take for them to dissolve according to your surgeon?
Are all your sutures dissolved now?
27 yo

- 01/2020: Nesbit surgery for a 50 degrees downward curvature with Dr.Faix (FR) : bad result

- 12/2022 : Surgery correction with Dr.Gelman US

- Now : Indentation on the left dorsal side with a rotation to the left that appeared, try Restorex

IwillbeatPD

Hey Middle Aged Man,

Can you tell me more about the hourglass you had and how you got that to improve? I believe you mentioned that gradually went away-which is really the one thing im trying to accomplish right now
Fit 37 year old athlete. Hinging and hourglass began Sep 2022. Tried VED, Restorex, tadalafil with no improvement. Implanted by Dr Hakky 11/28/23 with Titan touch XXL 26 cm no RTE's. Pre op 8.25Lx 5ish G. Post implant: 8.25 L x 5.5 G

MiddleAgedMan

Quote from: Alex83 on December 25, 2022, 05:00:39 PM
Oh right! How long does it take for them to dissolve according to your surgeon?
Are all your sutures dissolved now?
The superficial ones last two-three weeks, they're mostly gone by now. The deep ones (the ones used for the actual shortening) are supposed to last at least six months or so.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Alex83


Ok ! For my part I still have all the external sutures, my doctor told me that they could remain up to 6 weeks
27 yo

- 01/2020: Nesbit surgery for a 50 degrees downward curvature with Dr.Faix (FR) : bad result

- 12/2022 : Surgery correction with Dr.Gelman US

- Now : Indentation on the left dorsal side with a rotation to the left that appeared, try Restorex

MiddleAgedMan


A nurse removed the bit sticking out of the skin as they were chafing and some parts weren't healing properly as a result (this was after about two weeks). It's healed well since and I don't think they were needed for much more than a week or so, but I wouldn't have removed them myself. She only cut off the ends; the sutures inside the skin remain (though I think they are for the most part absorbed by now).
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Muttley

Hi MiddleAgedMan,

I hope that you are making good progress. Would you mind providing us with an update please?

Thanks in advance!
Muttley
Late 50s
Nesbit Procedure July 2023 which was successful
Official diagnosis 12/2021: Bend at the end @70 degrees upwards/@35 left

beaulieu1008

QuoteThe one negative issue is that the end of the scar that has been slow to heal seems to have become attached to the underlying tissue rather than sliding freely like foreskin normally does. This means I can't move my foreskin back over the glans which is a major concern. The nurse I spoke to didn't seem to think this was a matter of urgent concern, so I'm either hopeful that the issue will resolve by itself until I meet with the surgeon in four weeks' time,

Hi middleAgedMan.

How did this end? Did the skin come loose?

Was your curve just underneath your glans?

Thanks

60 years old. Peyronie disease since 2020. Upward curve 30 degrees. Thick calcified plaque, dorsal, just beneath glans. 2cm wide, 1cm long. No ED. Except soft glans.

MiddleAgedMan

Quick update 3 months post-op. Overall, the surgery was very successful; my penis is now almost straight when erect - there is a small residual upwards curve (maybe 10 deg or so) and unless I'm fully erect slightly bent to the left as the surgeon compensated for a congenital rightward bend and might have overcorrected a little. But it works just fine and sex is much better than before the surgery, both for me and my wife. My erectile function is just as good if not better than before. The issue with the foreskin remains but seems to be improving gradually; the surgeon told me this is common as when it heals it tends to stick to surrounding tissues. I'm on a waiting list for corrective surgery to fix that issue but it is quite possible that it will have resolved by itself by the time my surgery comes up (with the NHS being in the state it is, it could be many months). It's not an issue that bothers me much though anymore, so I'm quite happy to wait. I'm very pleased with the ouutcome overall, I have lost a few cm in length as expected (though that was already the case due to Peyronie's, the surgery just made the length the same on the dorsal and ventral sides) but it doesn't bother me at all and neither my wife, luckily! To anyone on the fence about doing this type of surgery I would definitely recommend it and I'm happy I didn't go for the riskier grafting option.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg

Mr man

Quote from: MiddleAgedMan on March 11, 2023, 10:04:31 AMTo anyone on the fence about doing this type of surgery I would definitely recommend it and I'm happy I didn't go for the riskier grafting option.
l
Thank you. I'm in the fence. Have a 30 degrees upwards bend. Have been offered nesbit procedure. I might go for it. Tha is.
Latest routine. Started l-lysine 3mg daily, l-proline 5mg daily. Increased vit c intake. Accompanied with almost daily vacuum therapy. Pumping to 100% Exercise caution! Made good progress. L arginine supplements and prescribed potaba are helping.

MiddleAgedMan

One year post-op update. The good news is that the scar tissue issue that made foreskin retraction difficult resolved by itself and I haven't needed any further surgery. The less good news is that the curvature has returned to some degree, I haven't measured properly but would guess I have a 30-40 degree upward bend, as opposed to around 10 deg after surgery. It seems not to be an issue for intercourse so provided it stays this way I'm ok with the result. I have no problems with getting an erection or any reduced sensation, so other than the minor curve everything works as it should. I haven't changed my mind about the choice of this type of surgery, I would still recommend it to anyone in my situation.
Diagnosed in 2019 initially ventral indentation, hourglassing w/ slight rightward curve
In 2020 developed dorsal curvature, ~70 deg
Tried traction (PMP), VED, heat, vitamin E, no change
Modified Nesbit surgery Dec 2022, <10 deg