1 week post operative concerns (nesbit)

[ADB]

Hi I'm a twenty year old from the UK who was diagnosed with congenital curvature of the penis (downwards) in January by a urologist. He recommended a Nesbit procedure based on the level of curve (approximated at 45 degrees) and the self esteem issues it had caused me throughout my teenage years. After discussing the details of the surgery and risks associated I agreed.

I am now one week post op and have some niggling concerns that I have noone to ask about and have received no guidance on after surgery. My aftercare after returning to the ward from theater was sub-par; instead of talking about what progress to expect, they merely stated time and again that 'it will improve'. There were some complications with the dressing, and a doctor diagnosed a haematoma. I asked how long it would take to clear up and he was very vague, and when I asked if it would cause permanent damage he was less than comforting. All in all the medical staff I have dealt with have been very dismissive and their lack of answers have left me with a lot of concerns which continue to grow during recovery.

Firstly, there is still a great deal of swelling along the entire penis - especially towards the middle and end to an extent whereby I cannot retract my foreskin (I was not circumcised through request) easily which makes checking and cleaning my stitches difficult; has anyone else experienced this? How long should I expect the swelling to be present for? Does it mean that I will not be able to retract my foreskin after recovery therefore requiring circumcision?

Secondly, when experiencing erections whilst still swollen is it common for there to still be a bend? When I first dared to check the shape after waking with a painful erection I was distraught and disheartened to find it was still bent to the same extent as preop. Could this be due to the swelling or is it likely that the procedure has failed? This is probably my greatest concern as I have a constant feeling that the suffering I have been through/am going through (I am experiencing a great deal of pain from the surgery and from a bladder infection due to catheter) has been worthless. Has anybody else experienced this? If so did it rectify itself once the swelling had subsided?

Thirdly, when I have experienced nocturnal erections they are much much shorter than my original length. I approximate that I have lost around 3 inches from 8" to 5". I understand that 5" is still acceptable, but with the bend seemingly uncured it is devastating as size was all I had going for me, and I feel I have lost it for nothing. I know it is early days yet, but is this shortening likely to be permanent or just due to post-operative trauma (I understand some shortening is inevitable with the Nesbit procedure) thus will improve?

Apologies for the length of this post, I started it intending to only write a few lines but I guess once you start voicing your concerns you kinda auto-pilot until they're all out. I hope anyone out there can ease my mind, even if it is an answer I'd rather not hear at least I can stop overthinking it all.

Regards,
ADB

[LWillisjr]

ADB,
You have really been through a lot. I've not had a Nesbit procedure, I had a different type of surgery. But I can relate to many of your concerns and questions. And I have spoken to others who have had Nesbit procedures. I'm going to post some answers here as I think others will want to read this. But I will also follow up with a PM to you.

First...  It is unfortunate that you are dealing with a less than responsive aftercare staff. I'm guessing they simply don't know much about Peyronies Disease and is why they couldn't deal with your questions. Usually aftercare is making sure your pain is controlled and getting you out of the aftercare facility.

Regarding the hematoma, I did have one post surgery. I went back to my doctor after 10 days and he actually drained this right in his office. It did fill up with blood again (he said it might) and is was actually about 4 weeks before the hematoma completely went away. So this will just take some time and I wouldn't be too concerned about it.

The swelling also takes time. I would guess at least another week. For me it was a total of 4-6 weeks before things actually seemed somewhat back to normal. This means the stitches gone (external ones) and swelling gone. You should be able to retract your foreskin over time as the swelling reduces. Being circumcised or not shouldn't be a issue. I would keep trying to keep stretching your foreskin back to keep yourself clean. Healing is a long slow process and not to be rushed.

I am concerned that you see no improvement in your curve with erections. I hope your doctor explained ahead of time what the Nesbit procedure entails. Internal sutures are placed directly on the Tunica on the longer side of your erection. This is basically a tuck to shorten the longer side which is why there is a loss of length with this procedure.

So in summary, healing is a slow process. Expect 4-6 weeks before the hematoma, swelling, etc. are getting somewhat back to normal. But I would DEFINITELY check with your doctor about your post op results. When do you go back for a post surgery followup?

Les

[ADB]

To those who think I have been ignorant/inactive in not answering the reply on this post, we have been exchanging messages as opposed to writing on here and Les has offered some really great advice and given me some peace of mind. I am still checking back daily so if anyone reading this has any advice on my original post this would be greatly appreciated.

Update: swelling is at manageable levels, and can with difficulty reach the degloving suture site; now I have seen it I'm concerned that even at 10 days it still appears to be an open wound with little healing. Erections experienced are still curved which doesn't seem to be changing despite a change in swelling.

If anyone has had any experience with any of these problems please let me know.

ADB

[keepitstraight]

Hello ADB. I will try to help or give my personal comment.
Swelling is perfectly normal, both in shaft and near the degloving line. Now there is one thing i cant answer because you've not done circuncision. Normally circuncision is advised and done but is not mandatory. After circuncision (done two times, one when i was 17 and recently when i did the correction procedure) swelling is totally normal and can take a month/ a month and an half. Through the end is more like a residual swelling and not a full one, so it is a steady process. No problem here. Swelling is part of the healing process (both the skin and inner tissues). Remember that your skin was cut, your penis was degloved, some inner tissues/layers where manipulated/incised/excised, etc... Its normal. I dont think anything went wrong with the foreskin cut area, just wait for proper healing. Swelling indeed is making the retraction more dificult.

What is more strange to me is the fact of a persistent curvature. It shouldnt be normal. Actually right after the surgical procedure the penis is checked for full correction of curvature and any persistent blood leakage (that could cause delayed hematoma). Is the swelling the cause of that persistant curvature, well i dont think. If the sutures are tight enough, if the sutures have good and apropriate tensile force, if there isnt any stitch/suture failure, if the measurments to correct the deviation where correct, there shouldnt be any persistant curvature. When i did the correction procedure and had my first erections they were tottaly straight.

About the shortening. The first principle is that you will loose some length. Thats a fact. But it depends on the technique used and the penile physioteraphy post op when it is advised. Some techniques you almost dont loose anything others you loose more. In Nesbitt, as far as i know is variable, depending on the degree of curvature, curvature assessment and surgeon expertise. I think you can loose from 1cm to 3cm (this last one is a bit extreme, not very frequent i think). But... yes normally after the procedure there is a temporary shortening. Normally is because the erections are still not fully rigid/complete and the tissues are recovering. You should wait at least 1 month and half post op to really assess what you lost or not.

Last think THERE IS ALWAYS HOPE :-) First contact your doctor and honestly and objectively expose you concerns. Second wait until at least one month and half/ 2 months post op to see more definite results. Well it takes longer but that should be enough to see if there is any improvement in the curvature and healing process, unless anything goes wrong. Third, well this one depends on your doctor and final results, but if you are sure the desired results were not achieved look for another doctor, the best you can. I repeat there is always hope.

All the best

[moteyi]

I had trouble retracting my foreskin after a nesbit and even now nearly 2 months later the foreskin is still tighter than before. That said, I'm not entirely sure that everything is as it should be as part of my foreskin, near the frenulum seems to be bunched up. I have an appointment with my surgeon in 2 weeks so hopefully will find out what is happening then.

Sorry can't add anything to your other questions other than to say that it is early days and you need to be patient and let things settle down before getting too concerned.

[ADB]

Hi keepitstraight,

At nearly two weeks the swelling is much improved and retraction of the foreskin is now much easier. I have noticed length increase will healing so this is a relief. The main worry now is obviously the persistent curvature and the incision site.

The consultant pre-op did mention that because I am younger it is likely that I will get stronger erections which could make the sutures fail. This is possibly why the curve has not been corrected. The reasons why the curve has not been corrected will hopefully be explained by the consultant at my 6-8 week check up.

The incision site itself now I can actually access it seems to be healing nicely except two sections where it seems the skin does not meet and is not healing, they look like open sores. There is also a pretty nasty smelling watery liquid there whenever I access it to clean the area which suggests it may be infected. I have an appointment at the GP tomorrow so will ask them about that then.

Thank you for your concern, advice and kind words,
ADB  

[ADB]

Hi Moteyi,

I can definitely sympathise with the difficulty in retracting the foreskin, but I'm not sure if I've experienced the bunching up near the frenulum. Can you elaborate on that? I hope the doctors you see at your check up can explain this and put your mind at ease

I'm not normally a worrier but with it being such a sensitive area and embarrassing to discuss with family/friends I've found it difficult to not worry about. I've learned patience is a virtue in this situation as many of the big worries seem to be resolving themselves.

Best wishes with your recovery,
ADB

[keepitstraight]

Hi ADB. No problem. There is one thing i forgot. Since you erections will probably improve (both in lenght and rigidity) the persistant curvature might be corrected. The true and valid assessement of the final result will only be achieved after full and normal rigidity is achieved when the tissues reach their complete tensile force and elasticity. So you might see an improvment in the curvature. But im not sure. About suture fail, if this is the case do you see any hematoma or blood leakage at the sutures sites (in case you know or feel where they are)? Some doctors give erections inibitory drugs to avoid these problems at least for the first 3 weeks post op. I think this should be protocol at least in younger patients. In my case it worked perfectly, actually i did not have any hassle or problem post op. Im 7 months post op and everything is great.
Lets see what the doctor says.

[ADB]

Hi keepitstraight,

He did mention that he was specifically not going to give me inhibitory drugs to prevent the erections prior to undergoing the surgery. In my naivety/embarrassment I didn't ask him why, in hindsight I wish I'd questioned him on it.

Post op as I said there was a great deal of swelling, like a lot (like girth of a jar swelling). I did develop a haematoma which I first noticed at the tip of the penis although was told this was likely to have moved due to gravity by the doctor in hospital.

Glad to hear your surgery has been a success, regardless of whether it's congenital curvature and you've suffered your whole life or Peyronie's and you've had to deal with the very sudden, confusing change to your penis, it must be a real relief to finally have a more 'normal' penis. Hopefully mine will improve with healing. If not there's always second attempts/reversal I suppose.
ADB
ADB