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Author Topic: Types of surgeries described here  (Read 14233 times)

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LWillisjr

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Types of surgeries described here
« on: August 31, 2009, 10:25:30 PM »

Questions often come up regarding the different types of surgeries for Peyronies Disease. These surgeries can be used for both Peyronies Disease and congenital curvature. I only provide a summary here as it would take too much to go in-depth. There are guys on this forum who have had each of the following procedures and will be happy to answer questions or point you to additional reference sources.

Congenital curvature
Congenital curvature is the term used when one has a curvature from birth. This is not due to an injury, but rather a birth deformity of some sort. This is often the case where the corporal chambers are of different sizes, which then causes a gradual curve during an erection. While you can try other forms of treatment, generally these are not effective for congenital curves. The surgeries listed below are used for congenital curvature correction.

Peyronies Disease
Peyronies Disease is a result of a scar or fibrosis that developed at some point after birth. While this is more often diagnosed in men over the age of 40, many men under the age of 40 have also presented and have been diagnosed. And it is not unusual to find teenage boys who have also been diagnosed due to an injury of some type. There are several forms of treatment which are further described in this forum. I only mention that here because these treatments should be tried before considering surgery. These treatment therapies attempt to resolve or soften the scar/plaque to allow the curvature to become straight again. If the Peyronies Disease has become stable and other treatments not effective, then surgery may be considered an option. The type of surgery is dependent on each person's doctor and a particular case. This includes one's overall health, degree of curvature during erection, and the ability to achieve an erection.

Penile implant
Do NOT overlook this procedure!  Many men who have had Nesbit or Incision, Excision surgery and later an implant, wish they had gone straight (no pun intended) to an implant and spared themselves expense, time, discomfort, and saved themselves the loss of length. An implant can be used for patients with any degree of curvature. If the patient is not able to achieve and maintain an erection it is the only option that makes sense, BUT even if erectile functioning is good an implant can straighten a bend or dent with no loss of length. The implant is used to effectively simulate an erection while also keeping the erection straight. The implant is very effective in simulating an erection via a discretely placed inflation bulb and release valve.  The two most popular models are thence AMS LGX 700 and the Coloplast Titan.  Patients report "having the hardness and performance of a 20-year-old again" - picking a high volume surgeon is critical.  Member Journals and discussion of implants can be found here: Penile Implants - PDS - Peyronies Society Forums

Plication Surgery
The first type of surgery described here will be plication surgery, also referred to as the Nesbit procedure. This surgery is often preferred for patients who have an erection curvature which ranges from 0 degrees (straight) up to around 35-40 degrees. This type of surgery is also only used for patients who can achieve and maintain an erection even if assisted with Viagra, Levitra, or Cialis. During this procedure, an incision is made on the existing circumcision scar (if already circumcised) and the skin surrounding the penis is slid back (this process is called "de-gloving the penis"). This exposes the tissue called the Tunica. This tissue is what stretches during an erection and gives the penis its shape. Sutures are then placed in the Tunica tissue on the long side of the curve. These sutures are drawn together to "pull" the erection back to a straight orientation. The skin surrounding the penis is then "slid back" into place. The sutures in the Tunica are permanent, and you will be able to feel for them under the skin.

Incision and grafting
This procedure is used for patients with a greater than 40-45 degree curvature and can achieve and maintain an erection. During this procedure, the penis is once again "de-gloved" as described above. Once the Tunica is exposed, several shallow incisions are made next to each other and on the Peyronies scar. The idea is to make shallow incisions in the scar tissue so that it will relieve and expand under tension (during an erection). A tissue graft is placed over the incisions to aid in healing.

Excision and grafting
This procedure is also used for patients with a greater than 40-45 degree curvature and can achieve and maintain an erection. During this procedure, the penis is once again "de-gloved" as described above. Once the Tunica is exposed, the scar or plaque tissue is actually removed (excised). A tissue graft is used to replace the tissue that was removed.
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