Graft surgical procedure - opinion

[emasculated]

@Knight: But this is a thread about developmental treatments. What's the point in discussing these if we end up talking about the same old crappy crap Frankenstein surgeries that exist for 50 years?

[jnbarizona]

I'd like to comment on what e2219e said as well, regarding removing the plaque prior to remodeling the area. Like Knight said, he's no doctor, and neither am I, but it got me to thinking(mainly because it makes sense), about another possible approach. What if I did the Xiaflex injections to break down the plaque(yes, I am aware of the risks of Xiaflex), then completed the treatment with my stem cells to rebuild the area. Anyone have thoughts on that strategy?  

[emasculated]

If the plaque is large and "ossified" that's not going to work.
I would just leave it alone in that case. Removing it might damage the neurovascular bundle and other nerves. Which often leads to impotence and / or loss of sensation. Often not immediately but 10 years hence. In 20% of cases new plaque grows at the ends where the graft has been sewn in. It's good to talk about better grafts because grafts tend to shrink and give also problems in the future. But the removal stage is already totally problematic. In any case if we talk about just better grafts then this thread belongs in the surgery section not developmental treatments and drugs.

[Knight]

@emasulated  - Youre really getting on my nerves. Why don't you let the moderators do their job and you stick to being negative about everything everyone else posts. That's what you're best at.

Have a great day.

[emasculated]

@Knight: You get on my nerves with the incessant accusation that I'm being negative. I'm not negative I'm just relaying the facts and the facts are not pleasant. Not my mistake.  

[james1947]

Cool down my friends, OK?
Try to accept each other as we are.

James

[Knight]

Sorry James. Out of a deep respect for you and many others on this forum I give you my word that I will do my best to honor your request.

[emasculated]

Since this has been made an independent topic, I will provide some evidence for my claims.

First of all the long-term study I posted some time ago in the resource library:
Impact of follow-up on results of surgery for Peyronie's disease: Time matters - Peyronies Society Forums

The only long-term study that I know of.
Notice: This is incision and grafting.
Many of the long term effects, especially the extreme shrinking of the organ after approximately 10 years is
due to the graft material. As there is no known way to place grafts which are anywhere close to the original structures
this problem has not changed.
Next I will provide evidence why excision and grafting is a very very very bad idea as well.

Quote from a current article:
Surgical Management for Peyronie's Disease
Robert L. Segal and Arthur L. Burnett
World J Mens Health. 2013 April; 31(1): 1–11.

"[...] Indeed, historically, total plaque excision was performed, which resulted in unacceptably high rates of ED.9 This outcome is thought to be related to veno-occlusive dysfunction as a result of structural changes involving the corporal bodies during erection.30 This practice has subsequently been abandoned and is not recommended. [...]"

See also:

Dalkin BL, Carter MF. Venogenic impotence following dermal graft repair for Peyronie's disease. J Urol. 1991;146:849–851.

Bacal V, Rumohr J, Sturm R, Lipshultz LI, Schumacher M, Grober ED. Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie's disease. J Sex Med. 2009;6:862–865.

[LWillisjr]

emasculated,

You have made it quite evident that you are completely against surgery, I get it. You don't need to keep posting references to the studies that you listed before. Many of us have read them already.

What I do find interesting is that you are about the only one on the forum that is so outspoken against surgery, and I think has led to some references of being 'negative'.

Don't get me wrong, I and others have always said surgery is a last resort. And it does have risks. One of the articles you posted did state that: The second group was followed much longer for 9 years. Here after this period of time there was severe increase in recurrence in almost 1/4 of the patients, which also means that 3/4 did not. Surgery has its risks and should be considered carefully. We've never said that surgery is a sure fire fix. It is an option for those who are not happy with their current quality of life with Peyronies and are willing to accept the risk to try to improve this.

The other thing that does not make sense to me is why you are so quick to advise others against surgery when you yourself are not a candidate for surgery. I looked back through your posts and you don't have any curvature with erections. Surgery is only for those who have severe curvature and not able to have intercourse, or not able to achieve an erection and willing to go the route of an implant. Even if I had to have it replaced every 15 years I would chose to have an implant to have sex with my wife than not be able to have sex at all with her. So I trust you can understand when those of us who once had severe curvature do carefully consider surgical choices. Yes there are risks and surgery is not guaranteed. Remember the goal of surgery is not to get your original penis back. That will not happen. Those of us with Peyronies have come to understand that you will not be restored to your pre-Peyronies condition. Surgery is only suggested as a way to regain the ability to once again have penetrative sex.

It is very frustrating when you can achieve an erection but you aren't able to have intercourse because you have a 50, 60, or 90 degree bend. So you can say surgery is bad, that it is 'Frankenstein' like, and that is has no place. You are entitled to your opinion. But those of us who have chosen surgery as an option are entitled to ours. I had no other option. I had tried VI's and traction and nothing helped. I knew ahead of time that my chances were a 70% success rate. And my doctor never promised me a miracle. But given a choice between not have intimate relations with my wife, or the chance to have relations again, I would make that same choice of surgery again. You will find many on the forum who have since said "why did I wait so long".

You said you had 2 friends that had surgery and they were not happy with the results. I am sorry for them. I also know of 2 people here in the U.S. that did not have good surgeries. But I also know about 20 men who have had the surgery and are still happy with the results. So yes, there is a risk. Each must make an informed choice of what risk they are willing to take to improve their quality of life living with Peyronies Disease.

And who knows..... even if my curve and deformity were to come back 10 years later. At least I had 10 more years of increased quality of life and the ability to be intimate with my wife. I guess if and when it comes back, I'll review the then new and updated surgical procedures and maybe chose again to have surgery for another 10 years.

[MeMo]

Definitely agree with LWillisjr;
Furthermore; as a person think to undergo surgery we do not suggest or offer person to do that, I'm here to know other people's opinion who already did surgery.
It is very important choice so anyone want to know about all aspect of it befor do that and it is the reason we are in this forum.
in my case I have no ED and curve but if my uro say me I have 60% chance to fix deformity I will take it, I am single and do not want to start a relationship with a deformed penis. in other hand the bigger plaque is in my mind which force me to refuse new relationship.
so if surgery gives me 10 years to build a family I will take it and i can accept and tolerate results after 10 years by their supports.
losing sensation? who care about it I remember to use delaying spray to reduce it before.
potential ED problems, without surgery there is same risk to have it during time with Peyronies Disease.
do not get me wrong; I am not going to say surgery is good or not, all i want to say it the risk factors and tolerance are extremely various case by case. the only important thing for me is to use the experience of people who did surgery before understand the situation and my risks when I am going to make my decision.
regards.