Surgery for Peyronie's Disease

[Larry H]

The information that I have is that bovine grafts have been used in the US. It's not clear if the single incision is a new procedure but it sounds like the plaque incision that is now being done in lieu of complete plaque excision that was the standard.

It appears that the perfect graft material has still not been found, although my data on this is dated back to 2003. Graft material is too numerous to mention but dermal grafts from the patient have been used.

In any case graft material has been the big question mark in reconstructive graft surgery. I'll try to get current info on what is now being used by most of the top Peyronies Disease docs.

Larry

[bicyclebob]

I would try contacting Dr. Anil Kapoor in Ontario. He is on staff at the hospital in Hamilton and is a teaching Urologist at McMaster University. I know he does other types of surgery, and he also does ESWT treatments for Peyronies Disease. Not sure if he does the surgery, but he is a big advocate for Peyronies Disease patients and is comitted to help.

[bentley]

VENOUS PATCH GRAFT FOR PEYRONIE'S DISEASE. PART I: TECHNIQUE.
Journal of Urology. 160(6-I):2047-2049, December 1998.
LUE, TOM F.; EL-SAKKA, AHMED I.
Abstract:
Purpose: We describe our technique of plaque incision and venous patch grafting to correct complex penile deformity associated with Peyronie's disease.

Materials and Methods: Graft material is obtained from the lower and upper saphenous and deep dorsal veins. The configuration, size and number of tunical incisions depend on the site and size of the lesion. In most cases an H-shaped tunical incision is adequate to release the contracture. With the aid of a vascular stapler several vein segments can be assembled easily into 1 piece to cover the defect.

Results: The incidence of penile shortening and erectile dysfunction, following other corrective procedures, is lessened with the tunical incision and venous grafting technique.

Conclusion: The venous graft provides an anatomical and functional tunical substitute. Results in correction of Peyronie's disease are highly encouraging.

Copyright (C) 1998 by American Urological Association, Inc.

[bentley]

The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie's disease.

Kalsi J, Minhas S, Christopher N, Ralph D.

The St Peter's Andrology Centre and The Institute of Urology, London, UK.

OBJECTIVE: To assess plaque incision and venous grafting (the Lue procedure) to correct the deformity associated with Peyronie's disease and to maintain penile length, evaluating the results over an 8-year period. PATIENTS AND METHODS: The penile deformity of 113 patients (mean age 45 years, range 17-71) with Peyronie's disease was corrected by plaque incision and saphenous vein grafting. All patients had stable Peyronie's disease and had a mean (range) penile deformity of 64.5 (20-180) degrees; the mean follow-up was 12 months. RESULTS: The result was excellent or satisfactory in 105 patients (93%), and the penis completely straightened in 97 (86%). Erectile dysfunction after surgery developed in 10 of 68 potent patients (15%) although they had arterial risk factors of diabetes, hypertension or cardiac disease that may also have contributed. There was penile shortening of > 1 cm in 29 men (25%) but this only prevented intercourse in two. Of the 51 patients with > or = 5 years of follow-up, the penis remained completely straight in 80% but the incidence of erectile dysfunction increased to 22.5% and penile shortening of > 1 cm to 35%. CONCLUSION: The Lue procedure is an effective long-term option in the surgical management of Peyronie's disease, but penile shortening after surgery remains a risk, and patients with vascular risk factors must be warned of the possibility of later erectile dysfunction

[bentley]

It ain't pretty, but it is pretty interesting. Read all the way to the bottom as there are several Peyronies Disease discussions
http://issm.info/prod/data/bulletins/16/issir-16.pdf
Cheers,
Bentley

[bentley]

UCSF Medical Center offers the latest surgical techniques for Peyronie's disease. These include plication, grafting and penile prosthesis.

1. Plication
2. Grafting
3.Penile prosthesis

Surgical technique
1. Stitches are put on the longer side of the penis to pull the penis to the middle
2.  Incision is made on the short side of the penis and a graft -- either a vein or pig small intestine graft -- is placed to match the long side
3.   A prosthesis is placed to help erection and straighten the penis
Penile length
1.Same as the length when penis stretched in the flaccid state
2.1/2 to 1 inch longer than the stretched penile length
3. About the same as stretched penile length
Risk of impotence after surgery
1.   Very small From
2.  10 percent to 50 percent depending on penile circulation
3.  N/A
Risk of nerve injury
1. Small
2. High
3. High
Operation time
1.  1 hour
2.  3 to 4 hours
3.  3 to 4 hours
Anesthesia
1.  Local plus sedation
2.  General or epidural
3.  General or epidural
Hospital stay
1.  Not necessary
2.  Overnight stay
3.   Overnight stay
Return to work
1.  1 day
2.  2 to 3 days
3.   2 to 3 weeks
Resume sexual intercourse
1.  5 weeks
2.  8 weeks
3.  5 to 6 weeks
Other considerations
1.  Cannot correct indentation or hourglass deformity
2.  Second incision needed if vein is used
3.  Higher infection rate


From Bentley: I get the idea that the different operations in the posts above are variations on a graft with the Ergydio procedure merely providing the4 calculations for the proper cut on the plaque

[Hawk]

Bentley,

I have to say that your link was very interesting.  I found several educational items and the surgery photos were as you said, "not pretty, but pretty interesting"

Thanks for the post.

[Delafoo]

I had surgery for Chordee, the congenital bend from birth.  I had it just over 2 years ago (I was 23).  Initially, there was a large reduction of sensation, which was to be expected.  However, mine lasted a bit longer than it should have, 18 months rather than the quoted 6 to 12.

I didn't lose much length at all, may be 1/16th of an inch.  The surgery went well, my insurace covered all except my deductable and co-pay, though I did have to retain a lawyer to get it done.

Overall, I am satisfied with the results.  I can now have sex, whereas before I could not.  I had a superior physician which I researched the hell out of before becoming a  patient.

Success with any surgery depends on physician skill, experience/experteise (which is where good research comes in), and how well you as an individual recover.

bb

[Larry H]

bb,

I'm delighted to see you posting here. Over the years your posts have always been informative and helpful. I remember you had a rather long period of loss of sensation, about 50% if I recall correctly, and it's good to hear that it has resolved.

Your comment about success with surgery depends on the skill of the physician is dead on, IMO. There are only a handful that I would consider if I elected to have the Nesbit (which I think is what you had) or graft. However, in the hands of a surgeon skilled in penile reconstruction, I think the results are outstanding.

My Best,

Larry

[bentley]

 Urology. 2003 Jul;62(1):105-9. Related Articles, Links  


Patient and partner satisfaction and long-term results after surgical treatment for Peyronie's disease.

Usta MF, Bivalacqua TJ, Sanabria J, Koksal IT, Moparty K, Hellstrom WJ.

Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.

OBJECTIVES: To assess the long-term functional outcome, patient and partner satisfaction, and predictive factors for unfavorable results in men treated with a surgical approach for severe Peyronie's disease. METHODS: Sixty-one patients underwent surgical treatment for Peyronie's disease between 1997 and 2001 and were retrospectively evaluated. All patients were assessed preoperatively with a detailed sexual and medical history, focused physical examination, and penile duplex ultrasonography. Nineteen patients underwent penile plaque excision/incision and grafting with Tutoplast cadaveric pericardial grafting material (group 1). Penile prosthesis implantation and manual modeling was performed in 31 patients (group 2a), and 11 men were treated with penile prosthesis implantation and pericardial grafting (group 2b). RESULTS: The mean follow-up of the patients was 21.9 +/- 13.6 months (range 12 to 48). Complete penile straightening was achieved in 15 patients (78.9%) in the excision/incision and grafting group. In the 42 men who underwent reconstruction using penile prosthesis implantation (group 2a,b), penile curvature resolved completely in 37 patients (88%). Long-term postoperative residual curvatures greater than 30 degrees occurred in 3 patients (15.7%) and 2 patients (4.8%) in groups 1 and 2a,b, respectively. One penile prosthesis (2.3%) was explanted in the second group for erosion. Patient responses to our questionnaire showed that overall 83.6% of the patients and 76.9% of the partners were satisfied with the surgical result. CONCLUSIONS: According to the results of this long-term, retrospective study, pericardial grafting can be used successfully after plaque excision/incision procedures in men undergoing surgical treatment for severe Peyronie's disease. In patients with Peyronie's disease and erectile dysfunction, implantation of a penile prosthesis and correction of the curvature with a graft can provide an acceptable, functionally straight penis without any increased risk of complications compared with penile prosthesis implantation alone.

[bentley]

Urology. 2003 May;61(5):999-1003. Related Articles, Links  


Nesbit procedure for disabling Peyronie's curvature: a median follow-up of 84 months.

Syed AH, Abbasi Z, Hargreave TB.

Department of Urology, Western General Hospital, Lothian University Hospitals NHS Trust, Edinburgh, Scotland, UK.

OBJECTIVES: To assess patient satisfaction with cosmetic and functional results after surgical correction for symptomatic penile curvature with the Nesbit procedure using postal questionnaire follow-up. METHODS: From 1991, 57 patients underwent surgery for a penile bend of greater than 30 degrees that was interfering with sexual function. Fifteen patients had mild to moderate erectile dysfunction on the preoperative assessment. In all patients, correction of curvature was performed by the Nesbit procedure after adequate preoperative counseling and informed consent. All patients were sent a questionnaire, and 42 men (76.4%) responded. The confidentiality of records was maintained at all times. RESULTS: Our study shows that 38 patients (90.5%) had either a straighter penis (n = 26) or minor degrees of curvature of less than 30 degrees (n = 12); only 4 patients had severe curvature. Seven patients complained of some bumpy and narrowed areas, and nine noticed reduced sensory changes. Twenty-one patients complained of penile shortening but 16 reported that this did not affect their sexual performance. Overall, 32 patients were fairly satisfied with the operation-10 (23.8%) of 42 men reported dissatisfaction because of multiple factors. Of these, 6 patients had responded that they would not have undergone the procedure if they were able to turn the clock back. CONCLUSIONS: Our long-term results after the Nesbit procedure are longer than that reported in any other series. Our results compare favorably with the short-term results of the modified Nesbit procedure, but simple/modified plication surgery results have not been so encouraging.

[Hawk]

Yesterday I was in a hospital waiting room and I found a fascinating article on SIS.  It was in the Aug/July 2005 UPMC Health Journal (Univ. Pitt. Medical Ctr).  It was about A recent application of a 1988 discovery by Dr. Badylak.  Dr. Badylak has interesting credentials.  He is an MD, PhD., and a DMV (Veterinarian).  He has worked a UPMC's Institute for Regenerative Medicine since 2003.  Dr. Badylak is the one that discovered that small intestine submucosa (inter-most layer of intestine) actually remolds wounds into normal tissue instead of scar tissue.  His discovery laid dormant for many years.

This SIS is void of cells but provides a 3-dimentional scaffold plus potent collagen growth factors that cause collage to rapidly form normal, properly aligned collagen matrix instead of scar tissue.  Collagen growth factors are not species specific so there are no problems with rejection.  Nature requires that intestines self-heal without scarring even though they are assaulted with acid, bacteria, viruses, and damaging substances daily.  Pig intestines are especially assaulted and have especially potent growth factors to regenerate whatever type of tissue they are used to repair.  When all is healed, there is no trace of the graft material.  It is totally replaced with regenerated tissue exactly like that of the rest of the organ.  No graft remains.  In many ways it is not a graft as we tend to think of them.  It is a temporary scaffold that is replaced by the organs own regenerated tissue.

To read it is one thing, but it drives the point home to see photos.  A dolphin with a horribly ugly wound that threatened loss of his dorsal fin was repaired without a trace of scar.  SIS has regenerated arteries and healed ulcers on diabetics legs that were otherwise doomed to remain chronic.  SIS has also been used to regenerate tissue in heart repair, repair hernias, and more

Question: Does anyone know if this is the exact same material currently used in grafting during Peyronies Disease surgery when they refer to pig small intestine graft?

[bentley]

1: Urology. 2001 Apr;57(4):753-7. Related Articles, Links  


Use of porcine small intestinal submucosal graft in the surgical management of Peyronie's disease.

Knoll LD.Use of porcine small intestinal submucosal graft in the surgical management of Peyronie's disease.

Knoll LD.

Center for Urological Treatment, Nashville, Tennessee 37203, USA.

OBJECTIVES: To report the use of a new acellular, xenographic porcine jejunal submucosal graft as a closure material for the tunica albuginea after plaque incision. METHODS: Twelve patients with at least a 12-month history of Peyronie's disease with a penile curvature of 70 degrees or greater were evaluated. Patient age ranged from 39 to 61 years (mean 50). Preoperatively, all underwent Doppler ultrasound after an intracavernous injection. Lyophilized (freeze-dried) small intestinal submucosa immersed in normal saline was used to graft the tunical deficit after the plaque incision using a subcoronal incisional approach. RESULTS: Surgical correction of the penile curvature was achieved in 11 of 12 patients. At a mean follow-up of 11 months (range 5 to 20), all patients were potent, with one requiring intracavernous injection therapy. One patient developed a 60 degrees curvature 6 months postoperatively and required reoperation. No reports of penile shortening, pain, infection, hematoma, bulging at the graft site, or evidence of a local immunogenic rejection reaction have been noted. CONCLUSIONS: At this early stage, acellular porcine jejunal submucosal grafts for coverage of cavernosal defects after Peyronie's plaque incision allow for satisfactory clinical results. The ease of surgical handling and placement and no associated comorbidities from harvesting techniques, coupled with no adverse reactions, make this material an anatomic and functional tunical substitute.

[Hawk]

Thanks for that post.  Overall, it appears promising.  I definitely am not slamming these doctors or the study, but it does raise some further questions I would ask if my organ were on the cutting block.

My first thought: How bad would it be to be the one guy that didn't improve or the guy that developed a 60% curve after surgery. (1 out of 6 or 17% )

Of the remaining 10:(a tiny study)

I am concerned with the short follow-up time, at the time of this report: 5-20 months.

It seems like they are covering a lot of ground with the phrase: "all patients were potent"    If they count a guy requiring penile injects as potent quote: "with one requiring intracavernous injection therapy",  then 99% of the men in the world are potent.   How many reguire Viagra?  How many have a diminished erection with or without erectile drugs?

I find this to be an interesting phrase: "No reports of penile shortening"  Reports by who?  Did they clinically measure before and after?

My last point is more of a question, or just my interest in the their teminology.  The statement: "make this material an anatomic and functional tunical substitute" is very interesting.  My understanding is that it does not "substitue".  It totally disappears and is replaced by tunica tissue.  I may be nit-picking here, since one could kind of argue that for a time it does substitute.  

Just a few thoughts about what many of these reports don't say.  I am interested in the date of this report and if the full report is available.

Bentley, could you go back and paste a link into that post?

Thanks!

[Larry H]

Hawk wrote:

"My last point is more of a question, or just my interest in the their teminology.  The statement: "make this material an anatomic and functional tunical substitute" is very interesting.  My understanding is that it does not "substitue".  It totally disappears and is replaced by tunica tissue."

Hawk,

Where did you read or hear this? Would this be the case for both graft incision and excision.

Larry

[bentley]

 As I am reading all of this. Excision dissects and removes all of the plaque whereas incision merely takes slices along the length of the plaque and then uses the media to fill the void so to speak. I am trying to find some articles or somebody that can talk to the different indications for either method. So far, what I get is the "case by case" rubric.  I , too, understand that the graft is ingrown with surrounding tissue.  Best Regards.
Bentley

[Hawk]

If you will look five posts down, you will see my post of 12/15/05 on small intestine submucosa (SIS).

The doctor that discovered this and who has used in on many organs on humans and on several other species says that the SIS is essentially a scaffold with high amounts of collagen growth factor bound to the scaffold (graft).  He stated that this causes the organ in question to generate its own tissue over the scaffolding without scarring and that NO trace of the original graft materal remains at the end of the process.  This material is broken down and absorbed by the body as the organ specific tissue fills the wound.

[bentley]

Hawk
This is what I read too. I think maybe the Doctors talk about the procedrujes loosely when we are all hanging onto the meaning of every word.  Do you know of an MD Near Southern California who is using SIS on Peyronies Disease?? Best Regards
Bentley

[Larry H]

Hawk,

SIS has been used often from what I see in my various reports, but there is no mention that it is anything but a replacement graft material. I don't see any mention that, in my words, it encourages the growth of new tunical tissue as is replaced by this tissue.

With being said I did a search for Peyronie's Small Intestinal submucosal Graft on Yahoo and came up with some very long reports that say exactly what you reported. Now this may only be the case in dermal grafts, but I'm going to try to read them in detail. They are medical reports and difficult to read.

Dr. Carson stated in a published paper "Peyronie's Disease: Surgical Management: Autologous Materials" "While the ideal graft substitute continues to elude us" and I believe the same thing is stated by Dr. Lizza in his paper that I referenced under NewsRoom a couple of days ago. You would conclude from these statements that the perfect graft material is still being sought.

Bentley:

I have a couple of papers, the one mentoned above, and one by Dr. Wayne Hellstrom at Tulane University that go into the questions you asked. I'll try to locate them on the internet and get the link to you. If I can't I'll get them to you in some other manner.

Larry

[Larry H]

Bentley,

If you go here, http://www.nature.com/ijir/journal/v14/n5/index.html, you will see a number of articles on Peyronie's. Unfortunatly, you have to be a subscriber to the IJIR to get full text articles, and it is expensive, but you can read the abstracts.

I have a number of these articles and will be glad to fax the two in question if you have access to a fax.

Larry

[Hawk]

All I know is the man that discovered SIS characteristics and invented the method of processing SIS has since used it in hundreds of surgeries such as human heart repair, major vessel restoration, and supervised repair on a dolphins dorsal fin almost lost from a UGLY, major, chronic wound.  The repair looked like healthy rubbery muscle and skin that had never been damaged.  

He specified that there are absolutely no cells (I find that a bit puzzling) in this material.  He said it consists solely of a temporary s3 dimensional scaffold that is rich with collagen growth factors that are not species specific.  They stimulate whatever tissue cell type they contact to replace the scaffold with their own tissue.  Like any scaffold, is disassembled after the reconstruction is finished.  SIS makes arteries produce new artery, muscle produce new muscle, dermis to produce new dermis etc.

All of this is in keeping with his mission at UPMC's Institute for Regenerative Medicine

I read this article once at the hospital and once more very carefully when I returned home with the magazine.  I will make it my goal to contact the UPMC to try to contact Doctor Badylak to resolve this understanding with statements like "we have yet to find the perfect graft"

[bentley]

I appreciate the offer Larry, but my fax machine is right in front of my secretaries who might just possibly read the material and talk  and speculate why it was being sent. I was thinking about how they might bring the papers into my office.
1.  Good morning Boss, you got this fax, but it didn't come through straight.
2. How come this came through all curled up.
3. Here is your morning papers, if you need me, I'll be just around the corner
Maybe I should just buy the subscription to that service. Best Regards. Bentley

[Larry H]

Bentley,

I understand completely. My office is in my home so the fax is no problem. These papers should not be seen by others in a business office as there are a number of pictures of the actual surgery. Also a before surgery picture with an induced erection and the penis degloved and very curved. The after surgery picture showes shows the member to be straight and much thicker. It's the in between pictures of the actual surgery that sends chills up your spine.

One thought is that most urologists subscribe to the journal and I would think they would print copies of the report for you if requested. The paper in question is from the 2002 14, 329-335 titled "Peyronie's disease: surgical management: autologous materials, by Carson and Chun, Uni. of North Carolina, Chapel Hill. It's the third paper down on the link I gave you.

Larry

[Will]

Larry...I noticed the research article you reference to was written by Dr. Culley Carson fron UNC Hospital...is he well known for this type of surgery?  Has any members here been treated by him?  Thanks.

[Larry H]

Will,

Dr. Carson is certainly in the top level of Peyronie's urologists, and is well qualified to perform surgery for Peyronie's. I don't know if any member of this forum has seen him, but perhaps we'll hear from one or more if they have.

Larry

[Ramjet]

I have had Peyronies Disease for almost 2 years. I am 59 years old. My Urologist has tried vitamin E and am currently taking Potaba with no improvement. My Urologist is now recommending surgery and has suggested two who are considered "experts" with Peyronies Disease. Dr. Steven Schlossberg in Norfolk, VA and Dr. Keith Van Arsdalen in Philadelphia, PA. Has anyone used either one of theses Doctors and with what success?

[Larry H]

Ramjet,

I don't know anything about Dr. Van Arsdalen, but Dr. Schlossberg and Dr. Gerald Jordan at Devine Tidewater Urology in Norfolk are renowned surgeons in both male and female genital reconstruction. It is stated that more reconstructive surgery for Peyronie's disease is performed by Devine Tidewater than at any other institution in the country. They have performed surgery for peyronie's thousands of times, and are two of the very best.

Larry

[number1]

My first post, so bear with me. First, Thanks to all for sharing the knowledge.
I've been reading in the Penis Surgery Clinic web page about their procedure for "moderate curvature with good erections" being "short eliptical transverse incisions made into but not through the plaque". Elsewhere I've read that this procedure is popular in Europe. I have not seen any reference made to it in this or the previous (am I allowed to mention that?) forum. Is the procedure a disaster? Seems as though it would not be as radical as grafts etc. Any knowledge or experience on this?

[Hawk]

Number1, it is great when a member starts posting an contributing the the forum.  Thanks for helping to make it work.  The procedure you are describing may be trhe Lariche technique.  There is a paper in our Resource Library area the Larry and Flexor worked together to provide.  They got it translated innto english a couple months back.

[bob]

I'm interested in seeing if Crookedselfesteem still occasionally logs onto this forum... and if so, he could provide us with an update on the results of his surgery. I believe he had to do some exercises as well. The last time he posted was in fall 2005.

[Michael]

Hawk asked that I cut and paste this from another section:  only too happy to oblige. If you have already read this, I did add a postscript at the bottom...

Sorry--  been too busy to get back on line to report!  We drove to SF Friday, waited probably 20-30 min to get into a room.  Dr Brandt, who introduced himself as Dr Lue's Fellow, did the initial screen and first sonogram.  He felt the thickness of the plaque was not too severe, we chatted a bit about the kinds of treatments men are trying out there.  He said he was aware of maybe 30 different things that men are taking or doing... and that to his knowledge, none of them provide any improvement except minute amounts in isolated instances. We got into a better room, and Dr Lue took over. He wanted a bit different angle on the sonogram, so re-did it, and then went over what he feels are the options most of us have.  First, in the case of early treatment, is an oral med with various side effects (sorry, it is nothing new, but I can't pull it out of my brain this second) which he said was not likely to help me as I feel I have stabilized after about 14 months. I told him I came in fully prepared to discuss surgery, as I am practically incapable of having intercourse... and what I can accomplish is more than awkward and generally uncomfortable. The only glitch was that they could not locate my pictures (I said That's odd-- I just saw them on the Internet the day before!) (Side note: both men have wonderful senses of humor, and as soon as we traded shots we got very relaxed... I'm sure he uses a lot of the same lines on most patients, so I won't reveal them, but they go a long way in removing the anxiety of the situation)  The three surgical options are plication as the easiest and least invasive (I can straighten any penis, easily, in about 20 minutes... but the question is whether the erections you can get now, if straightened, will be good enough to give you a satisfactory shot at intercourse.")  Second is grafting-- much more complex, with greater danger of impotence due to nerve damage-- depending on how erect you can get beforehand, and with how much aid it takes (chemical) you can run up to a 50% or even higher chance of becoming completely impotent. This is microscopic surgery, to delicately separate the nerves from the plaque; excise the plaque, and rebuild with the graft. He says it can take him two hours just to deal with the nerves... but he does several of these every week, and is confident in his ability.  The third is the penile implant, and while he did not recommend nor am I interested in jumping straight out there, because my wife is an engineer, he just had to show it to us! He does at  least two of those a week-- says they are a marvel of engineering, and has successfully even implanted one in an 87 yr old man! We wanted to know if I started with plication and was not happy (my fear is that the waist and hinge effect I have would remain the same, and it would be conducive to further injury.)  Answer is yes, if you don't mind two separate surgeries.  Likewise, if door #2 does not do it (say, the surgery is physically successful, but you become impotent) you can go for the implant. He says all of the sensations remain with an implant; ejaculation is possible (I already know i can ejaculate with a 25% erection, so that's not hard to believe.)  What he could not say was whether have so much waisting that the simple plication would be sufficient (since the pictures were still MIA, it was getting late, and he had not done an injection to witness my erection himself.)  So, he asked me to email the pictures ( I did this weekend) and he got back to me this morning with two options: (I have severe narrowing at the base of my penis)

Graft the curved portion and the narrow portion--4 hour operation with
30-50% chance of impotence

Straighten the curved portion with sutures and graft the narrow parts.-2
hour operation with a 10-20 % chance of impotence.

Option 2 would make me look pretty much as I used to, but shorter (at this point, I would be happy with straight and no pain).
Option 1 gives me back some of what I lost... at higher risk.

I'll be thinking about this; my wife already says it's my decision, and she's with me no matter what...

That's it for now... I'll let you know what I decide.

Later postscript:  Forgot to tell you--  I asked if the real incidence of Peyronies Disease was really only 1%, and he said he believes it's at least 3-5%--  that with the advent of Ed meds, men who would have just given up before now have decided that this is something they should report and see if they can conquer.  I said something about him specializing in Peyronies Disease--  he said he doesn't: but everyone comes to him for it anyway!  Last he said "Guess how many new Peyronies Disease patients I have seen today? (my appt was at 2:30; did not leave until 4 pm)  he thought for a minute, counted up--  "Nine!"  This on Good Friday, and I saw only one other patient waiting for another of the many doctors in the Uro practice...  Guys:  We are not the Few... We are Legion!

[Robert]

   My peyronies syptoms started to manifest themselves after I turned 18. I first noticed something was different when I wasn't able to urinate straight forward and had to hold my penis 'straight'. Over the next few months, my penis curved to the left a little more each week until it eventually was curved almost 30 degrees to the left. Unlike most people with peyronies, I don't remember any specific trauma to my penis. Looking back, the most I can figure is that it got damaged in my sleep; perhaps rolling over while I had an erection.

  I never told anyone, because it was so embarrassing. I had casual girIfriends and even more casual sex; but in general, I would go to a party and stop going any further with a girl than making out. Even in my dreams, my bent penis stopped me from going all the way with imaginary girls. I'm not bad looking and I'm really out-going, but I was always worried that someone else find out and spread the naked truth. Even harder, was that my friends would always joke about curved penises; saying that they were caused by over-masturbation or trying to force ones penis into places too small for it.

  Finally, after 6 years, I decided to start looking into treating my curvature. Around February of 05, I searched the internet and found this site, among others. They were all very helpful and I found out how and why a penis would become curved. Sure enough, after looking up some information on curved penises, I found out I wasn't alone in my plight. There were other guys like me. My disease had a name. I hadn't even noticed the scarring under my shaft's skin until reading up on the subject.

  I immediantly started trying some of the home remedies on myself. I started taking Vitamin E and some other pills meant to help with arthritis. I would rub cocoa butter into my shaft twice a day. I also found a website that explained techniques for jelqing and began performing those exercises.

  It took a lot of time out of my busy schedule to take pills 3 times a day, rub butter into my scarring twice a day, and perform 45 minutes worth of jelqing every night. 6 months later I hadn't seen any change in the curvature of my penis. I'm not one to do anything half-assed, so it was very disheartening, because I was very vigilant about my treatments.

  Finally in August, I got up the courage to see my family doctor. This had to be the hardest thing I have ever had to do. I had never talked about this to anyone; and to tell this to someone I had grown up with and knew really well made me want to be sick. He was very understanding and was glad that I had took it upon myself to read up on my disease. He referred me to a urological specialist and after an examination he suggested that since it wasn't physically impossible to have sex, I might be better off just forgetting about it and going on with my life.

  Perhaps seeing how devistated I was by this, and how determined I had been to take treatment into my own hands, he setup an appointment with a urological surgeon. This doctor filled me in on all the risks and side-effects of surgery; and even though I was scared of losing length, rigidity, or even becoming sterile; I decided to go ahead and make an appointment to have surgery on my penis.

  This type of surgery, in Canada anyways, has an up-to one year wait time. Shortly after my last doctor visit, I met a sweet girl and we started dating. the sex was good, I never brought up my curvature and she never mentioned anything either. Last month, after nearly 9 months of waiting, I got a call from her at work. We are living together and she had 'accidentally' opened the letter sent to me from the hospital, confirming a surgery date. When I got home I came clean to her about the surgery. I was scared, because it had never come up before and she was literally only the 4th person I'd ever told this to.

  To further complicate matters, she insisted that she had never noticed my curve. Maybe it was all in my head and it wasn't bent as much as I thought. Up until now I wasn't scared about the surgery. I knew there were risks, but I had outweighed the possible dangers and complications by justifying that it would be worth it to just be 'normal'. Now a girl was saying that my penis didn't even need straightening.

  I decided to go for it anyways. I signed the acceptance sheet and got a pre-op assesment. I had come too far, worried far too long, and had put too much time and effort into this to turn back now. Penile straightening is only considered 'day-surgery', which means that you only need to stay overnight at the hospital for observation and are released the next day. My surgeon felt that the best way to deal with my curvature was to simply 'pinch' the right side of my shaft to straighten the curve. There is the least amount of things that can go wrong with that procedure, as opposed to grafting from the 'healthy' side. the down-side is that it can shorten one's erection by up to an inch. I also found out from my surgeon that it was only going to be a 45 minute surgery and the anesthesiologist even gave me the option of just having my lower-half frozen for the surgery. I had been up really early that day, so I chose to be put under and have a nap.

  When I woke up, my penis was wrapped in gauze and I had a catheter to assist with urination. There was very little discomfort and the next day I was released without any complications. My only instructions were to hold off on sex for at least a week and to keep my wound clean. I was really horrified when I took the bandaging off at home. My penis was swollen, bruised, and had an incision all along the right side. For the first few days after surgery, I couldn't get get an erection. I was glad, because I'm sure it would have hurt a lot, but it scared me a little. 5 Days after my surgery, I had my first post-op erection. I woke up with an erection and it hurt because of the stitches.

  It has now been almost 3 weeks since my surgery. My erection is stiff, I didn't lost any length, and my penis is straight. I still have an incision line on the right side of my penis, but it feels so good to have sex and not feel awkward. Even the feeling of a straight erection in my pants is wonderful to experience again.

  I would definetly suggest surgery to anyone with peyronies. While it's not for everyone; I can say that after being scared and embarrassed of my erection for 6 years of my life; I feel like a new man. I talk to girls without any hestitation, I won't turn my back in public swimming pool's change rooms this summer, and I'm not constantly distracted during sex by thougths of inadequecy. If you have had stable peyronies for more than a year and sex is difficult or embarrassing. Please visit your doctor to discuss the options that are available to you.

[Hawk]

If you go to our website and click on "News" you will find a news release featuring Biowire.  I believe it is closely connected to the SIS discussion in posts 60 thru 70 below.

Thanks to Mark for bringing this to our attention and passing the information on..

[Michael]

Two months ago I posted about my consultation with Dr. Tom Lue at UCSF.  I spent some time thinking over my options; tried to have intercourse a couple more times (basically not possible: my bend was more like a kink, maybe an inch from the base, and upward, so that if  I was laying on my back, my erection would be tight against my body, and trying to force it away caused much discomfort, resulting in quick deflation.)  I finally decided that if I was to go through life with no chance of successful pentration, I would take the leap and have the surgery.  It was scheduled for May 25, last Thursday. On Wed I went through the pre-op paperwork with admissions and consultations with the anesthesiolgy dept and again with Drs. Lue and Brandt.  This time my pictures were available; we did another sonogram; and Dr. Lue laid out what he considered to be my updated options: do only the plication to straighten my penis; do grafts on one or both sides of the waisted section (the left side was indented more than the right, but both together made me much narrower at what I consider a crucial strength point) or do the entire H procedure (grafts on both sides and the delicate separating of nerves from plaque across the shaft). Dr. Lue felt the risk of impotence after the H procedure was high; the only gain would be about a half-inch of length. I chose to go with grafts on both sides, reasoning that a straight(er) penis strong and potent enough to penetrate would  be a godsend considering where I was. I was average at best at my largest, and I have lost some of that... but my wife assures me it has never been about size, and I decided it was in my best interest to believe her. The next decision was whether to go with my own vein or the pig intestine; the downside to the leg vein is that you lose that entire vein, and the incision is reported by most patients to be much more painful during recuperation than the penis incisions.  The downside to the pig intestine is, well... that your penis will oink every time you use it!  (Sorry-- had to use one of his zingers, at least!)  The downside to the pig parts is that you have to wait a few extra weeks before attempting to use your penis-- it is replaced by your own tissue entirely in about 4 months, though you can use it in about 8 weeks or so...  I went with the pig intestine; figured I would hedge my bets and save the vein in case I need it in the future for something even more serious.

I reported at 6 am (UCSF is an hour drive from home); went to a holding bed with Dotty alongside me; had the IV placed; and when it was my turn to go my anesthesiologist said he would start me with something to relax me.  That's the last thing I remember before waking in recovery! Dotty says my eyes rolled up, and I mumbled "Now THAT's a nice high!" (I guess you can take the boy out of the 70's but not the 70's out of the boy!)

Anyway, I woke in recovery nearly four hours later, around noon; Dotty was exhausted, and I wanted to rest and kept slipping back to sleep.  No pain; but some vague discomfort that I finally determined to be the result of my first experience with a catheter... I told her to go home and rest and pick me up in the morning as planned.

Dr. Lue stopped by after his second surgery, about 4 pm.  He told me I had made the absolute right choice: the erection drug would not  get me fully erect (apparently, not even close) so he felt I already have enough nerve damage that him trying to separate and set aside  more nerves would have probably not resulted in a successful ability to achieve an erection afterward. he said he pumped me full of saline; got me like a rock, and saw that my bend was more pronounced than my pictures had indicated. He did the plication to straighten that out, then did the grafts on both sides, and he felt that part went very well. He thinks I may eventually be bigger around at the base than further out... but time will tell.

So, I was wide awake after that; spent the evening reading; nurse changed the ice pack every couple hours. I got up and walked a few laps around recovery about 9 pm, then watched TV until midnight. I had one Vicodin all day long, and that was only because I was doing some regular coughing, and the sensation of trying to clear your lungs with a catheter in is unpleasant... not painful, just uncomfortable. I did take two more Vicodin at midnight to try to get sleepy; it worked, and I passed the night just fine.

The catheter was to come out at 6 am; I was anxious enough about that joy that the nurse offered me a bit of morphine before she did it. That might have just been a psychological ploy, because I took her up on it, but never felt any effect from the dosage.  The catheter slipped out just fine; again uncomfortable, but not painful, and that part was over.  The worst part of the whole surgical experience was the catheter... and in the scheme of things, that was nothing!

They did up the paperwork, and I walked across the street and up to Dr. Lue's 6th floor office so he could show us how to change the bandage and take a last look. I am black and blue from stem to stern, but pain-free. My only problem after three days: with no hair around there to be a buffer, my scrotum tends to stick to my legs, so I have to walk bow-legged to free up my boys!

I'm going back to work on Tuesday (if not a holiday weekend, I'd have no problem returning tomorrow.) While I don't feel like doing my daily 3-1/2 mile walk because I want to limit my swinging... I felt more than good enough to go to an antiques fair today and cover all 400 booths at a leisurely pace.

The next two months are Wait and See time... but I can tell you right now that I feel better for having done this; for having taken the step... even though I know there is the risk that for whatever reason--physically or psychologically-- I may end up unable to achieve an erection.  Each of you has to come to your own conclusions about what course to take, but for me, I did the right thing. Having one of the best surgeons around in my back yard didn't hurt, of course, but making the decision freed up so much STUFF that I was holding in that I feel way lighter than I did before. Before I went in, I finally told my sisters and my kids what was happening to me; and coming out of the the surgery, I feel like I can speak much more freely about it. I feel like warning everyone I care about that we men are not indestructible: we go through our lives thinking we can't be hurt; not THERE, at least... but as WE all know, we sure as hell can be.

I will check in and keep you updated. So far, so good. I will admit that I felt from the beginning that if surgery was a viable option for me, I was going to take it. I was scared to death of having a scalpel taken to my privates: what man wouldn't be? I am here to tell you that the pain I imagined was so much worse than what I am experiencing (literally:  none) (wait until my first erection; I may change that tune!) that I am astounded.  I have looked at the pictures; I actually have the picture of the bloody penis from the A4400 literature saved to my desktop; (I thought "That must be excruciating!")  Well... it's not.  And that's what I want to leave you with for now: there are many reasons not to have surgery to correct your Peyronies...but pain is not one of them, at least not in my opinion.

[Steve]

Wow!

Thanks Michael for the insightful account of your surgery.  It sure gives me something to think about, although I'm not sure I'm ready for that step just yet...I'll wait and get the long-term report from you (and even then, the thought is painful if the surgery isn't).

Steve

[Hawk]

Michael,

What can I say?  Every word or phrase seems inadequate.  I think the best I can do is to say that I was deeply touched by your post.  Though this first-hand account gave some great technical information, I think it was the deeply human touch that impacted me.  I am rooting for good things in your life, and I for one, thank you for that post.  it is an incredible contribution to to the Peyronies Disease community.

Hawk

[ComeBacKid]

Michael,

Good to hear from you man, I'm glad you had no pain after your surgery and hopefully you will have a speedy recovery.  Also it seems like you cleared the first hurdle of possible surgery risks or mistakes.  The only thing and I think this will be the test over time is did the doctor damage any nerves or do you have a loss of sensation.  In other words will you be able to get an erection hard enough for sex and how much sensation will you have lost?  But you did yourself a huge favor in picking Dr. Lue, I've heard many good things about him from the people I've talked to on the phone, and he is one of the best in the world.  It will be interesting to see how your function is after the surgery.  I truely hope you achieve a positive result in your recovery and get the results you were looking for.  I think for many of us here we are not yet at the surgery point as we are trying any and all alternatives.  But in your case it sounds like you lost function totally and the clock simply ran out on you, and so did the options.  I truely hope you get the result you were looking for.

Good Luck,

ComeBackid

[Michael]

Thanks to all for the public and private messages of support.  Today I had enough of taking it easy; did my walk with Dotty (though it was a tad bit slower than usual); did my crunchers and push-ups... no problems!  My bruising is already starting to diminish at the edges. Still no pain:  if it weren't for the bandages and the "Schweddy Balls" syndrome from being shaved, I don't think I'd know that this happened.

A few more notes: since UCSF is a teaching hospital, there are a number of uro specialists who will come out of there one day fully armed with all that Tom Lue can teach them.  He had just flown in from a conference in Atlanta the day before my surgery... when I left that appt. there was a young man (maybe 28-30) from mexico waiting to see him... His nurses told me he has people come in from all over the world.

I don't have any insurance info yet: I have good insurance through Dotty's work (ppo with HP), and no one said anything about problems with the pre-authorization, so I don't think this will be bankrupting me.  They write it up as "Correction of Penile Deformity"...

I said before that Dr Lue has a great sense of humor.  I decided to get him on the post-op office visit the morning after:  I went in and said I had a problem; that I couldn't understand why, with PPO insurance, they set me up with an HMO prosthesis-- and I pulled my breakfast banana out of my pants.  I thought Dotty was going to have a heart attack; Dr Lue had a good laugh, too.  You know, when crying gets old, laughter becomes the best medicine...  Back to work tomorrow: I'll check in as i wait out the next two months!

[Tim468]

Thank you for a terrific post. I am grateful that I got to read it, and that your honesty can give me hope.

Tim

[dcaptain]

Michael, let me just add to the chorus of "thank you"s.  That was an incredible post, offering amazing insights into your thought processes as well as the clinical side of what happened. It will be very helpful no doubt to everyone who reads this board.  I wish you the absolute best recovery.

dcaptain

[Liam]

Found this about a new graft material.  It is called Surgisis.  The article date is 5/22/06.

http://www.urotoday.com/search/contents/article.asp?cat=ed&sid=&tid=&aid=4931

[ComeBacKid]

Michael,

How are you feeling now that its been a week or two since your surgery?  Hows the healing process coming along?  Keep us updated!

ComeBackid

[zigwyth]

Wow Michael, your post blew me away. I literally went outside of work and broke down out of sheer happiness. I will continue to try the alternatives 1st as Iv'e only had this crap for about 6 months, but at least I know surgery is definitely a possibility. Hell if I can go through a Hair Transplant which was pretty wild, I can do this then if necessary. Thanks and Good Luck Zig the Twig

[hopeful]

Robert- It is now June 19th,- how are you doing now-1st-did you loose girth or length?-what about sensation- I did not get your age- how old are you- look forward to your answer-

Hopeful

 

[Michael]

I'm now at 3-1/2 weeks and all is about where it's supposed to be, I think.  Stitches are still hanging on, but the incision sensitivity is mostly gone.  I was told not to attempt anything for 8 weeks, and I'm holding to that. The few times I have visualized any kind of sexual activity, I can feel the blood rush to the area... so I know the reflex is good.  It does kind of ache when that happens, which pretty much cancels out the rush, so... I have not had an erection.  I dream about having them, but if I swim into consciousness and check, I find it's just that:  a dream.  I will say that's an improvement in and of itself: before the surgery, I could barely even dream about it.  Oddly enough (I hope it's odd, and not future-predicting) I have several times dreamed of having a decent erection, attempting intercourse... but finding I only have about two or three inches to use! Think I've got some subconscious worries over size? Nah!

I have promised my wife some playing around to show I have not abandoned her... and because I know I'll react physically, and I'm afraid of the results, I keep wimping out.  I've got chance it; they want blood in the area to help stretch all the tissue... and she deserves the attention.  Lordy, lordy:  I'll let you know how it goes.

[Hawk]

Michael,

Now promise us that you won't begin a life of non-stop ectascy with a newly perfected penis and forget we are still sitting here waiting for information  

I was told not to attempt anything for 8 weeks, and I'm holding to that.... they want blood in the area to help stretch all the tissue.

Michael, could you clarify these two quotes.  Is it ok to get an erection if you do not use it?  Do they encourage or discourage an erection?  Do they prefer a partial erection?

Thanks

[Michael]

Hmmm, Hawk--  Gee, I already live a life of continuous ecstasy... I just don't have sex!  (Dotty-- that was for you !)  My take was that once the stitches hold well (about 4 weeks in, like right now) having an erection is not bad; just don't be playing with it. No trauma or man-handling allowed (no woman-handling, either). The specific directions were no intercourse and no masturbation for 8 weeks...  That said, getting some blood to flow in the region is healthy and healing.  They put in the extra long-lasting stitches to make sure you don't split your incision open with an early, uncontrolled erection (usually nocturnal, since there is no brain activity to get in the way and calm that puppy down). So, without actually being told in so many words, but implied:  partial erection certainly not bad if you have the controll-ability, but if it hurts, it will take care of it itself. I have not pushed the envelope, and I have not had any nocturnal erections, but with a little imagination or a great hug and a kiss, I can get the blood moving there, and if my penis perks up just a bit, I consider it good news. I'm pretty much going to wait until he signs me off, unless something spontaneous happens before that time-- and I will not risk using it, at any rate. I've waited this long; a few more weeks is not going to hurt.

[hopeful]

 It is now June 24thh,- Questions- -did you loose girth or length?-what about sensation- I did not get your age- how old are you- look forward to your answer-
how long with Peyronies Disease

Hopeful

[Hawk]

Hopeful,

Just a thought, Michael probably does not have a firm grasp (pun intended) on that yet since he is not to have full blown erections yet.  Actually, in his words,

I have not had an erection.

[kiki]

My question is pertaining to sex after the operation. My husband of many years had a Nesbit Tuck three weeks ago, to correct curvature. The operation was his idea, although I agreed with it. The operation went fine. Within a couple of days afterwards, my husband began to be  awoken in the night with nocturnal erections. At first this was very painful, but the pain medicine helped and they would go away as soon as they came almost. The doctor said it was good that everything was working.  Last night, even though it had been only three weeks, he wanted to attempt sex. In the middle of the night I did not have the mind set to stop him, and sense it was not intercourse I thought it would not hurt anything.  I was wrong about that. The results seemed fine until the point of ejaculation. At that point, he was in intense pain. He screamed loud enough to cause the dogs outside to start barking. At first I thought it was a scream of ecstasy, thinking this procedure was great. However, the scream was one of pain, and he barely made it to the bathroom in time to relieve himself of the nausea. Afterwards he said it felt as if hot molten lava was erupting through him. I'm assuming this is because he did not wait another week, as his doctor had asked. However, reading in this forum, I noticed where two people mentioned they were asked to wait 8 weeks after surgery.

I would like to know if anyone else has had this operation, and if so, when sex resumed. Also, if anyone knows if my husband's reaction last night was normal under the circumstances.

Thank you.