Grafting Surgery - Comparing Excision Vs Incision

[newguy]

Both incision and grafting and excision and grafting are or can be carried out under similar circumstances (when curve is beyond 40-45 degrees and the patient can maintain an erection). As such, does anybody have a view as to which surgery is preferable for people in that position, and which one the top guys (levine etc) favour? Is one more popular than the other? I would ask for the success rates but that likely depends on who is carrying out the procedure. Perhaps there is a general consensus that one is preferable to the other though. What are your thoughts?

I'm happy that the new format of rhe board allows us to flesh out these discussions somewhat, as in some ways I think many people avoid contributing to discussions relating to surgery. Thanks very much to lwillisjr for describing types of surgeries and to jackp for enlightening us about Penile Implant Surgery.

[LWillisjr]

Newguy,
Great question. My very limited assessment seems that this may be a doctor's preference. I can tell you that I believe Levine's preference is "excision and grafting" as I know this is what procedure he performed on me and another patient of his that I am in contact with.

I also know of someone who recently had "incision and grafting" by doctor Munarez (sp?) in Boston.

Each procedure supposedly have their advantages and disadvantages. It would be interesting to see if others have experience with with either of these and can post them here.

[jackp]

Les / Newguy

The grafting surgery is a good option for those that do not have any Erectile Dysfunction. As I read the literature it is also advisable to wait about 18 months after onset of peyronies. I understand that about 1/3 of peyronies will do like mine, the curve will go away but leave you with about a 20% loss of penile length and then the Erectile Dysfunction starts.

I know with the onset of peyronise it is hard to wait that 18 months. Mine started in 1995 and we did not have the options then we have now. Do not be too hard on doctors that tell you that. What you need to do is find a Male Sexual Function doctor not a general practice urologist. The right course of action for you during that 18 months may be Vitiamin E, Potaba, Pentox, etc. I do know now that the sooner you start the VED exercise the less loss of length you will have and it will help keep your penis healthy. 

Male Sexual Functions specialist like, Dr. Levine, Dr. Lue and Dr. Milam are hard to find. It is worth the time and effort and be willing to travel. I live in an area of over a million people and had to travel to Nashville.

I guess what I am trying to say is that there are options out there for you. You have to do what is right for you. Personally at my age I do not have the 10, 15, 20 or however many years it may take to find another option. 

Just my take on things.


Jackp

[LWillisjr]

Jackp,
I'm in total agreement. There are many therapies during the 18 month stabilization period to try before surgery. I was just commenting on Newguy contrasting "Incision and grafting" vs. "Excision and grafting".

[newguy]

JackP- I certainly agree with you that!! The question was more relating to those in a position to have this type of surgery. Nobody should even consider surgery unless they have tried other options first and have been pain free for many months. The question doesn't relate to my specific case.

[Peregrine]

I see Jackp is on line.  I phoned you once regarding the prosthesis which was recommended to me by one uro at a major medical center in Los Angeles.  I can have an erection so I am revisiting the specialist at the other major medical center in Los Angeles to see if grafting may work.  I've read Levine's book Understanding Peyronies Disease, and it led me to find out about venous grafting.  I worry about infection w/ the gortex part of the prosthesis and the prosthesis colonizing of bacteria itself.  Anyone have success w/ grafting?

[jackp]

Peregrine

Feel free to call me again.  As for the grafting surgery Les will be a better source of information than myself.

I will send you a PM again with my number.

Jackp

[LWillisjr]

Peregrine,

Feel free to post or PM me.  I had the "excision and grafting" surgery and quite happy with it.

Les Willis

[Jazz]

Hello, all.  I haven't posted in awhile, but I have been reading new posts lately.  My gentleman, after many trips to two doctors, vep shots which had no effect, and much soul-searching, has decided to undergo surgery with Dr. Carson.  He is, of course, having second thoughts already, but he was told that surgery is probably his only option.  I'm just looking for some feedback at this point, and some advice on using the traction device pre-surgery. 

At his last appointment he had at least 4-5 docs in the room.  They told him that he had the best chance for the best possible outcome with Dr. Carson and his team, which is good news.  We were also told by another well-known expert that Dr. Carson is excellent, and had taught him the technique. His Doppler revealed that he has excellent blood-flow, that of an 18 year-old according to them (he's 57). Also good news.  Bad news, they said he may lose up to 1/3 of his length.  Due to the severity of his condition, they want to do a combination surgery (part Nesbitt, part excision and grafting or combo of something else?). They also said there would be a great deal of pain.  Obviously those observations are scary for him, though I have told him they may just be giving him the worst-case scenario.

Has anyone had this combination surgery?  I wasn't sure when reading the posts on surgical techniques.

Also, Les, he is ordering the fastsize, and was told there was a dvd explaining its use, but would you be so kind as to explain how Dr. Levine advised you to use it pre-surgery, or was it post-surgery only?  His surgery is scheduled for mid-October.

Thanks.  Jazz

[LWillisjr]

Also, Les, he is ordering the fastsize, and was told there was a dvd explaining its use, but would you be so kind as to explain how Dr. Levine advised you to use it pre-surgery, or was it post-surgery only?  His surgery is scheduled for mid-October.

Thanks.  Jazz

Jazz,
I can't remember if I got back to you on this or not. The DVD video is the same one posted on their web site. I believe you can download it, but I'm sure you must have it by now since you have the device. Levine instructed me to wear it as on the DVD as part of my treatment before surgery. I kept wearing it up to the time of surgery, and then Levine had me start wearing it again maybe 6 weeks after surgery (can't remember the exact time he had me start wearing it again). It helps to stretch the graft and regain some length lost during surgery. Since your friend is having a combination procedure, I don't know what the post surgery therapy will entail. Please keep us posted.

[Jazz]

Les, thanks for the reply.  We've looked at both sites - he did not get the fastsize as ordered, but got an andropenis instead, no idea why since the receipt said fastsize - trying to convert the darn cms to inches and vice-versa is a pain. Fastsize site is much easier to understand, I think.   We weren't told whether he was to use it pre-, or only post-surgery.  We figure can't hurt him to try it out pre and at least get used to wearing the thing.  Unless, of course I got the numbers all mixed up when trying to put it together - that may be a big ouch!   

Jazz

[Hawk]

I would not worry about measurements.

Add enough extension rods to comfortably fit the penis length.  Once on, the tension spring can be turned to apply gentle stretch.  If it is not enough tension, adjust by adding more rod inserts accordingly.  Knowing the actual number of inches or cm of the traction device is not critical or even helpful.

[Jazz]

Hawk, we really appreciate the advice.  He adjusted it somewhat - it is confusing since they ask to measure flaccid then erect - guess that's for comparison before and after.  He said it made his glans turn blue (looked more white to me) - don't know if the noose was too tight or not - will look at the troubleshooting section again.

Jazz

[LWillisjr]

He said it made his glans turn blue (looked more white to me) - don't know if the noose was too tight or not - will look at the troubleshooting section again.

Jazz

Jazz,
The tension of the strap can be a bit tricky. It will take a little trial and error. It just needs to be snug enough to keep the glans from sliding out while under tension.

[UK]

LYON, France -- November 16, 2009 -- Defect coverage by a collagen fleece following partial plaque excision to correct penile curvature secondary to Peyronie's disease shows promise in a recent study, researchers announced at the 12th Congress of the European Society of Sexual Medicine (ESSM).

Georgios Hatzichristodoulou, MD, Technische Universität München, Munich, Germany, and colleagues presented early results from a trial of 76 men with stable Peyronie's disease who were unable to perform coitus. A collagen fleece coated with a topical fibrin-based tissue sealant was used for penile defect coverage after corrective partial plaque excision or incision.

A variety of materials are typically used to cover the defect of the tunica albuginea, Dr. Hatzichristodoulou explained here at his presentation on November 16. All materials, autologous or nonautologous, he noted, need to be "precisely adjusted and sewn into the defect, which can increase operating time and cause defects when the autologous material is removed."

Sixty-five of the patients in the study had dorsal penile deviation, 7 had lateral left deviation, and 4 had ventral deviation.

The study excluded men with erectile dysfunction.

Overall, 65 patients underwent partial plaque excision, 3 had plaque incision, and 8 had a Nesbit procedure.

Results showed "very good" correction in 64 patients (84.2%). Twenty-seven patients (35.5%) had erections after 4.9 days post operation.

Twenty-two patients (28.9%) developed a postoperative haematoma, which dissolved in most cases, and 70 patients (92.1%) had postoperative glans sensibility.

Dr. Hatzichristodoulou said these results are on a par with the results of other surgical procedures with respect to treatment success, complications, glans sensibility, and the patient's ability to obtain an erection.

Besides a shorter operating time and ease of use, the procedure employed by Dr. Hatzichristodoulou's team provided an additional haemostatic effect.

He emphasised, however, that longer follow-up is needed, and additional clinical outcomes need to be measured to gauge the true usefulness of the procedure.

[Presentation title: Correction of Peyronie's Curvature by Partial Plaque Excision and Defect Coverage With Collagen Fleece -- Early Results of a Prospective, Multicenter Study. Abstract PO-07-004]

http://www.docguide.com/news/content.nsf/news/852576140048867A852576700068CE12

http://linkinghub.elsevier.com/retrieve/pii/S0302283802000246

[Tim468]

Greek doctors, fleece.... I know there's a joke in there somewhere.

Tim

[jpl]

Hi,
This is my first post on this site. It's OK to move this post, if not posted in the right forum. I'm 61 years old, with Peyronies Disease for about 2 years now. 80 degrees curve to left. 1-1/2cm x 3cm plaque at base. Saddling  around the base of penis. Have been receiving treatment through the VA. After 12 verapimil injections, there were no changes. I have decided to move forward with excision and grafting.

Being such a big decision! I decided to have surgery done with Dr. Levine. I would rather go with the best in the world, rather than the best in the VA. No offense to the VA. They have been a big help. Just wanted to go with a doctor that has preformed more surgeries with excision and grafting. And being able to hear from his patients. The results of their surgery. Thank you Les!!!

I am willing to take the risks of surgery. If this surgery don't work. I will move forward with an implant. This whole Peyronies Disease thing has not only worn me down. And, has also had a huge effect on my wife! She is the best, to say the least. We have been married going on 32 years. I am more concerned for her, then myself.

My surgery date is scheduled for Mid January. And very much looking forward to taking this step forward, that I have waited for, that seems like forever! My wife feels the same way!

My heart goes out for the wives of Peyronies Disease suffers. As much as for the men. My wife has been very supportive and understanding through this time of challenge. Her desire for sexual activity have decreased. And I am not happy at all, with the changes Peyronies Disease has left me with. Decreased size, deformity, feeling ashamed of myself. Not being able to talk to anyone about it. I don't want to be viewed or exposed. Not even in front of my wife. I can tell that she has no desire for my penis with this Peyronies Disease results. Yes, I am desperate for a hope of correction and not feeling ashamed anymore of my appearance.

If I can be of help to anyone? I will do my best, to answer questions. To the best of my knowledge and experience.
Sincerely,
JPL

[jpl]

January Excision and grafting surgery.
Flew into Chicago (solo) Wed. 1-20-10 for pre-op with Dr. Levine.
Excellent staff and Dr. Levine great guy!
Filled out paper work and ultrasound.
Stayed the night at Marriott Medical district Wednesday night. (It's only about 2 short blocks away)
Best way to travel to and from the airport, is to take the shuttle. ($27. each way)

Thursday morning checked out of Marriott.
Brought my belongings to the hospital with me.
Had to be at Rush hosp. at 9:30 prep for 11:30 surgery.
The staff at Rush was top notch in every way!!
The surgery took about 1-1/2 - 2 hours.

Dr Levine told me the he was very satisfied with the surgery.
And he had removed about 98% on the peyronie's scar.
And it was bigger then he thought.

I stayed in the hospital overnight.
They made me feel like a VIP!!
My dick was wrapped in a ace bandage type of wrapping.
It looked looked a large 6" Corn Dog!
Pissing was a slight issue.
It was more like a water sprinkler than a stream.
That was because of the swelling and tight bandage wrap.

I left the hospital Friday at around 1:00 PM
After being checked by Dr. Levine staff.

Went back to Marriott to catch the shuttle back to O'Hare.
Back home Friday evening.
Plane ride was uncomfortable by due able.

Started getting continuous erections.
My dick was way sensitive while wrapped.

I was instructed to take off the bandage on Monday morning.
Dick was swollen and sore. Balls turned blackish some minor bruising also followed.

Erections lessened after bandages were removed.
It feels great not having that scar tissue any more.
My dick already looks better!

My next instructions are to start message therapy and stretching device.
This would be one week after surgery.
And to wait 6 week before getting layed.

So far, if feels better for me and my wife, looking at my dick.
Well, that's about it for now.

I would highly recommend Dr. Levine and Rush hospital!!!

[slowandsteady]

Balls turned blackish some minor bruising also followed.

Thanks for sharing the story. I had my penis turn black after hernia surgery. I might have worried less had they told me about that possibility first. 

[Tim468]

Congratulations jpl!

It sounds like you and your wife are headed towards a lot better emotional place. It must feel terrific.

Tim

[LWillisjr]

jpl,
Thanks for posting your story. I'll call you later in the week to see how you are doing.

Les

[jpl]

Tim68,
Thanks for the reply.
Yes, things seem to more on the positive side. After surgery.
BUT, it's going to take time, to restore intimacy.
A women is different than a man. To same the least!!
To different machines!

Only with God's help, will we be able to recover.
Peyronies Disease has taken a toll on our relationship of 32 years.
And, has also taken a toll, on my wife with her emotions and feelings.

Peyronies Disease is not just about the guy!!!!
Although it is a very heavy life challenge for a man!
Peyronies Disease can really mess with your spouse's head.
We are both trying to work through this thing together.
And plan to beat it!!

Although I am pleased with the surgery results already!
It's going to take time for physical, emotional, and relational healing.

If. I can be of any help, to anyone else?
Please reply or PM me.

[jpl]

Les,
Thanks for all your support, prayers, and concerns!
You had a lot to do, with my decision to go with Dr. Levine.
And, very glad I did!

I hope that I will be able to be help to someone else.
Like you helped me.
To return that favor.
It's really hard for people to understand.
How Peyronies Disease messes with your life.

But, the good news is.
There is hope!

[jpl]

Tim68.
Thanks for reply.
Yes, things are better with my wife.
I think she likes, what she see's already.
Even with the stiches.

It's such an unbelievable feeling.
To have the plaque removed, straight again, and everything else seem's to be functioning fine.
We're both looking forward to the sixth week!!

[jpl]

Going on my fourth week of post op.
Stitches are almost gone.
But, can still feel some in there.

I was circumcised, and still sore around gland area.
Graft area is still sore. But has gotten better.
Bruising is gone.
Dick is straight, with very slight bend.
Erections are continuous, but still need improvement.
Climax induced 1 time. (works)

Following instruction per 1/4 tab Viagra everyday.
And using Fast Size for 4 hours per day.
Seems that cold weather exposure can promote soreness around graft area.

Would really like to try getting laid.
But, don't want to go there.
Waiting for week six!

For whatever it's worth!
It's good not looking at my dick in a deformed state.
Looked at my surgery notes.
It said, "I was 90 degrees curve to left"
12.5 pre op
14.5 cm length post-op.
I feel that some size has been lost since onset of Peyronies Disease.
Probably 1-1/2" or so?
Hope to gain some back with fast size?
Actually I think it is helpful so far.
Seems to be something, I don't want to do, but need to do.
Promotes soreness around the gland.
Hopefully, the soreness will stop?

[jpl]

Going into week 5 after excision and grafting surgery.
Everything is pretty much the same as last week.

Morning erections are continuous, but not completely full.
I am noticing, less rigidness in the in the upper 3" of penis. (when erect)
That was somewhat of the same issue, prior to surgery.

I'm hoping that will change with time!
Graft area is still tender and sore.
Message, seems to bring some relief.

Getting more accustom to fast size.
But, still not crazy about it.
Instructions are, to increase usage to 8 hours a day.
That seems to be, "An over the top request!"
Wearing this contraption device, with clothing in public.
Is not something I would do.

Dr. Levine recommended not to use VED at this time.
Because of the type of surgery that was done.
Maybe down the road, after more healing has been accomplished.
Don't want to mess anything up.

Trying not to bring up, the dick subject to often, with the wife.
The subject is getting worn out!!
There are more positive things to talk about.
Then dick issues!

[jpl]

Finally week six is over.
Still minor soreness and tightness around the circumcised  area.
Feels like a few minor stitches are still under the skin feeling??
Graft area is still tender, and will take quite some time to be fully grafted.
Erections are continuous but not fully rigid.

Intercourse was possibly and able to climax.
Wife said, "It feels better for her, since the surgery has been done,
but, increased rigidness would be better"
Deformity is gone. That's a major accomplishment!

Continuing with fast size device.
Usually 3-4 hours a day.
I think the stretching, is helping.
But over stretching is not good.
And needs to be a gradual progression.

I guess time will tell, as far as, complete recovery.
Don't want to stress over present issues.
Have to remind myself, that it's only six weeks since a major surgery!
Need to stay positive and thankful for the improvements I have.
Can think about other options, if and when that time comes.

I will not be posting weekly anymore.
But, will post any new breakthroughs or problems as they may arise.

[newguy]

jpl - It sounds like you're on the road to recover. I'm very happy for you. Please do continue to keep us updated

[jpl]

Just want to pass on some updates, since my surgery 1/21/2010.
Things have healed fairly well.
The appearance has definitely improved.
Looks handsome!

Erections are continuous.
But, still lacking rigidness and full erection.
Shortness in length is noticeable. 1-1/2"
Still have slight bend.
Climax is possible.

Fast Size is unrealistic, for the time required for usage.
I really don't like to use it.

Now that most of the healing is done.
I asked my DR if I could use a VED.
He said, "Yes" and wrote a prescription.
I have not received it yet.
But, looking forward to it.

I do realize, that complete healing will take more time.
But, in the meantime. I want to do what I can, to help the healing process.

In the future, if things don't work satisfactory.
I will look into an implant.
Don't want to go through life, without a hard dick.
More so for my wife.

I'll post again, after I experience the VED.
No regrets going with DR Levine!!

[tperry1010]

JPL, 

I have been emailing John and Les since 09" about going to Dr Levine for Excision and grafting surgery. I finally decided to make the trip last week, and was disappointed there is a 3 month wait to get in to see him. The Doctor emailed me , and said he would be delighted to help me, but he was "backed up"

I went ahead and scheduled with a nurse for December 14. I'm a little nervous , because she seemed a little ignorant about what Peyronies was all about. Maybe it was just me.

I have a 90 degree bend straight up.

In that you seem to be the last guy to see him, I was just curious if you had to wait 3 months.

Thanks,

Tom

[jpl]

Tom,
I don't know what girl you spoke with.
Most of the time, I spoke with Gina.
Very helpful and concerned person.
She would never hesitate to contact Dr Levine, and get back with me, if I had any questions.

I think you will find Dr Levine a doctor who will live up to his world renown reputation.
And is really a good guy.

Rush Hospital is over the top!!
Was very impressed.

Hope all goes well for you.
I know and remember the anticipation of having this surgery done.
Overall I am glad that I had this surgery done.
My appearance below, is nothing to be ashamed of anymore.

I must admit there was some loss of size. (length)
Not really thrilled about that.
It's been 9 months since my surgery.
And continues to improve.

The fast size is over priced and not practical.
But, just use it as he says.
I now use a VED. With Dr L. approval.
And think it's much better and more practical.

But don't use the VED until he says so!!
Healing time is important!

I get erections, through the night. And every morning.
And whenever I get intimate with my wife.

Rigidity will improve over time.
I Still use small doses of Viagra, when I feel it might be needed.

Things are still not the same, prior to Peyronies Disease.
But, much better that what it was!
I hope it will improve even more with time.

Wish you the best with your surgery.
And look forward to hear back post surgery.

Don't hesitate to cotact me, if you need to.
Read some of my previous posts, after surgery.
They might be helpful?

[Brightdog]

The Doctor emailed me , and said he would be delighted to help me, but he was "backed up"

I went ahead and scheduled with a nurse for December 14. I'm a little nervous , because she seemed a little ignorant about what Peyronies was all about. Maybe it was just me.

Keep in mind that a busy doctor's staff might sometimes have to take a vacation - you might have been talking with someone who was filling in or relatively new and not quite as secure in her knowledge. And as more and more people find this site and flock to the doctors who good job of treating this disease, expect the wait times to increase.

Best of luck with your appointment - I hope the treatment plan works!

[LWillisjr]

Tom,
Not sure what you meant about you  "scheduled with a nurse". Typically the scheduling people you talk to are simply that, schedulers. And I doubt that the know much about Peyronies Disease. When I was going to see Dr. Levine, his assistant was a female nurse named Terri. The only time I spoke to either of them outside the office was when I called the office if I had a problem and then generally Terri would be the one to call me back.

It also took me about 6 weeks to make my first appointment with Dr. Levine. But I'm certainly glad I did. Also for your first visit, they should also arrange for you to have a penile scan on the same day. Dr. Levine used to require this for every new patient. So I had the ultrasound that morning, and my first appt that afternoon. So part of my delay in getting in the first time was his office trying to coordinate the ultrasound on a day that Levine had an opening.

I would also encourage you to document any questions you might have in advance, and even taking pictures of your erection and bringing those with you as well.

Les

[jpl]

Just wanted to give an update for 1 year post-op excision and grafting surgery.
Things are better than they were prior to surgery.
Penis does not look deformed or scrawny.
Penis looks normal.
Loss of size is about the same 1-1/2 - 2".
Curvature when erect is about 30 degrees left.
Better than 90!!
Erections are regular through the night and morning.
Erections are about 75-80%
Not fully rigid.
I think I would have more size, if I were 100% erect.

Intercourse is possible as well as climax.
But not 100% satisfied due to lack of full rigidness.

Been using VED for good penile health and blood flow.
Slow progression.
Viagra helps.

I did try injections.
Better result. BUT, don't want to stick needles in my dick.
Something wrong about that for me!

Have taken a step back with approaching sex.
Maybe twice a week now.
Wife is loving. But not really 100% satisfied.
I couldn't ask for a better wife!!

I don't want to beat myself up over this whole Peyronies Disease thing.
There is more to life, than how big and hard my dick is!!
Maybe thing will get even better, as time goes by??

Some days I considering implant surgery.
But don't want to pull the trigger to quick.
I would really like to talk with more patients that have under gone this type of surgery.

JackP thank you for all your imput and support.
Would like to hear from other veterans, from past implant surgery.

I'm glad I had the surgery done.
Yes, It's better since the surgery.
But, still not the same. Prior to Peyronies Disease.
Just a lesser dick problem.

Still want to give it more time to recover.
Want to enjoy and love life everyday.
While I wait!!

[Luciano]

As I think I am going to choose operation, I have a stupid question.
Everybody speaks of size reduction of 1 1/2 to 2" average.

I allready have about 2" size reduction since it started. (not considering the curbe)

So here my question:
When you talk about size reduction, is this to prior Peyronies Disease, or prior operation.
(I meen for me.. 2" size reduction prior operation would meen for me:
minus 2 inches since I contracted the desease adding another 2 inches after operation.. meens minus 4 inches.. )
I can live with minus 2 inches as it would be the same as now, but minus 4 inches ...... => depression

Luc

[LWillisjr]

Unfortunately it really varies. I know of one person on the forum who didn't lose any length. I lost 2 cm but this was from the beginning of Peyronies Disease onset to after surgery. So I can't tell you how much was due to the surgery and how much was simply due to the Peyronies. I also know another guy who lost 3 inches.

All these examples were from excision and grafting procedures. I can't speak for plication or other procedures.

[Brightdog]

I did not have a measurable loss on one side from the Peyronies Disease - one side of my penis was still engorging to 8", but the other side was not (and hence the 160 degree curve). So I measure my loss from my previous erect length. It means I went down to about 5" and I am now back to over 6" and still working on recovery.

[jpl]

Just wanted to update my progress, since my last report.
On April 6Th 2011. I pulled the trigger on implant surgery.
(AMS 700 LGX)
Had the surgery done in CA. USC Dr Boyd.

I was really not happy with the results, from excision grafting surgery.
Caused more Erectile Dysfunction problems.
Today was 5 week post-op visit.
Recovery is slow with this type of surgery.(to my surprise)

Had to go 5 weeks with a half hard on 24/7.
In order to keep things straight while healing.

Spent 2 1/2 days in the hospital.
Painful with a tube in your dick the whole time.
I think that was the worst part?

Things seem to look better, and fuller.
Size recovery is about the same as pre surgery.
But, will increase with time. So I'm told!

I got the go head to have sex 
My wife and both, already feel, this was the better choice for us.
Not ready to really report beyond this for now.
Will post again in a few weeks.