Reasons of ED after grafting procedures

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DELETED

Can someone explain the mechanism of emergence of ED after grafting procedures such as tunical circular grafting with saphenous graft or MoST technique or similar techniques and why these techniques performs with penile prosthesis in almost every cases even if EQ before procedure was almost 100%? Why risks of venous leakage after grafting procedures are so hight? If you have any scientifical papers that describes this mechanism in details, please post link of the study.

Jack1909

Scarring is the first cause of impotence and any surgery gets some amount of it (this why you can experience ed also after undergoing a simple Nesbit, plication, Stage,...). That being said, it's pretty obvious that grafting is far more invasive..they literally take you off pieces of penis replacing them with materials which are anything but similar to the original ones.  
31 yrs old
Severe congenital curvature. 3 straightening surgeries
Big lump/stitch w/ left deviation after 2012 surgery
Severe ED after last one in 2014. Still crooked
Slightly improved w/ shockwave therapy
Looks like only one side of my penis works

LWillisjr

AlexSamo,
Where are you getting your data from. You are implying that ED is inevitable with grafting procedure which is not true. It has been said many time on the forum that the quality of one's outcome of surgery is dependent on the surgeon.

Jack1909,
Grafting involves the Tunica. Blood flow for erections is deeper in the corpora chambers. So I can't agree with your post that scarring from surgery causes ED.

Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

JohnWright

I had plications installed in June 2016. In all the reading ahead of making a decision, there was no indication or suggestion of scar tissue in relation to the plications.

Regarding the cut line 1/4" below the glans and around the shaft, there is no visible evidence that I even had surgery.

Regarding ED: the degree of ED I had prior to surgery remain unchanged.

Sensitivity: In my case, and for my adult life, my dick was so bent that the glans absorbed most of the friction from sexual encounters (and also was banging into my wife's ovaries all the time which meant slowed activity 100% all of the time). Post surgery, my shaft picks up 100% of the friction and my orgasms are an entirely different, mind blowing experience like I never knew possible.

Jack1909

I can't believe we are still arguing on something that is outright obvious. It looks like all the people suffering from post op ED I encountered just came out of my mind.
31 yrs old
Severe congenital curvature. 3 straightening surgeries
Big lump/stitch w/ left deviation after 2012 surgery
Severe ED after last one in 2014. Still crooked
Slightly improved w/ shockwave therapy
Looks like only one side of my penis works

Jack1909

I don't know how it's possible stitches sutures excisions and incisions inevitably produce scarring and fibrosis. Most of the people who undergo a penile surgery have fibrosis, what makes the difference is the amount of it. That's basically what any truthful surgeon would say. Come on, that's unbelievable.  
31 yrs old
Severe congenital curvature. 3 straightening surgeries
Big lump/stitch w/ left deviation after 2012 surgery
Severe ED after last one in 2014. Still crooked
Slightly improved w/ shockwave therapy
Looks like only one side of my penis works

DELETED

Quote from: LWillisjr on December 18, 2017, 06:05:28 PM
AlexSamo,
Where are you getting your data from. You are implying that ED is inevitable with grafting procedure which is not true. It has been said many time on the forum that the quality of one's outcome of surgery is dependent on the surgeon.

I remember in a few articles was mentioned that in almost 50% of cases grafting procedures caused ED, but the mechanism of ED wasn't described. Is it was because of significant trauma of cavernouse tissue and scarring? Or is it because material of patches isn't ideal and don't matched with original tunica? Or maybe it's because "new" tunical size is bigger than nominal cavernous tissue volume and it leads to venous leakage?

lessor

I dont know how you dont know that but jack1909 is very correct, touch the tunica will cause scarring and it is more dangerous if its with excision and grafting because with that process more fibrosis will occur and the veno-occlusive system may be more compromised, so the probability of ED is greater


From ncbi: Grafting techniques are more complex than plication as they require extensive dissection and lifting of the neurovascular bundle within Buck's fascia. Postoperative ED risk is higher with grafting techniques than with plication, therefore patients need to have documented preoperative erectile rigidity (Erection Hardness Score ≥3) (5). In this regard, it should be emphasized that a proper preoperative assessment of erectile function is strongly
recommended. Initially, total plaque excision was performed in the surgical treatment of Peyronies Disease, with the objective of removing all of the plaques of the affected tunica albuginea. However, these early excision procedures resulted in higher rates of postoperative ED (19). Currently, total plaque excision is not commonly performed and not recommended.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893511/

Here you can read about it too https://www.mypeyronies.com/grafting-surgery.html
http://www.jsm.jsexmed.org/article/S1743-6095(15)33574-8/pdf
https://www.urologicalcare.com/erectile-dysfunction/peyronies-disease/

Anyway i dont know if you want to know about this process why do not you look for it on the net? There is a lot of medical information on the net and it will solve many of your doubts.  

DELETED

lessor,

I'm searching option for straightening my penis without any length loss, ideally I want to add some length via grafting procedure, that's why I'm asking this. I don't believe in everything that doctors saying, because some of them saying that grafting procedures 95% succesfull and not dangerous, while other saying that in almost 80% of cases it leads to ED. I don't want implants, if I'd needed them, I'd choose MoST technique with implants and add up to 2-3 cm extra length.

lessor

If you dont have ED grafting is an option
No one wants the implant until you see it is the only option, because to ED or a very big curve

DELETED

Let's say, if some top-surgeon will ideally perform grafting procedure with best graft material with minimal risks of scarring, does it mean that risks of ED will be very little? Or causing of ED is still not only scarring, but also venous leakage after enlarging size of tunica?

lessor

I believe that the importance of a good and experienced surgeon is very important so yes in my opinion a good surgeon can reduce the risk of ED
The cause of ED can be scarring which in turn can produce venous leakage since the scarring can prevent veins from being trapped correctly thus affecting the veno occlusive system

Jonbinspain

Much of the recovery after this kind of surgery is in your own hands.

I had surgery via the Egydio technique 2 yrs ago now. A small graft was used as some of the badly calcified plaque had to be excised.

For several months after the surgery I did have trouble maintaining an erection. Part of this may be down to my age - I'm in my mid/late 6o's, but in very good shape. - but I found that daily use of both VED and traction not only gave me virtually all my size back, but considerably strengthened my erections too.

Now, with the aid of a Cialis I can get it up and keep it up no problem.  

TonySa

That's great Jonbin, do any of your posts address your progress and experience w the surgery?
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

DELETED

Ok, skills of surgeon, quality of graft material and post-op care is very important, but what else? What if I say that I want slightly longer graft that I needed, for example, if I have 15 cm penis, but I want to have graft that could add +2 cm to my erect length, isn't it can lead to some problem with veno occlusive system? There was Austoni bilateral grafting technique for girth augmentation with two longitudinal grafts on sides of the penis. And this technique have been performed without implants. So what if doing similar technique for length augmentation without implants?

lessor

I am almost sure it is almost impossible get lenght augmentation without implant plus sliding technique.
I think with a grafting the best you can get and that if you are very lucky it is your pre peyronies lenght no more.
There is a technique which consist in cut the suspensory ligament but it works more in flaccid state than in erect state  and it affects the angle

TonySa

You may want to check out the medical article on penis lengthening for peyronies patients.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893519/
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Jonbinspain

I have posted my experiences of the surgery before.

A brief recap: I settled on surgery after the best part of 4 yrs fighting this affliction with just about everything you've ever read of and probably some you haven't. Nothing worked, the curvature became a little worse, the ED too.

So, it was a matter of who was I going to trust with a scalpel on my dick. After quite a bit of research, I settled on Dr Kuehhas and the Egydio Technique. Surgery went well, I was under for 2.5 hrs. Very little residual pain, although my dick looked like it had been run over by a truck!

The main difference that I found was - and this may well be to do with my age and/or the severity of my condition - was that contrary to what I was told, sex after 4 weeks!?  forget it!  It took far longer for me to start to get back to normal.

The erections came but were difficult for me to maintain. I was on the point of going back to be checked for leakage or whatever, but I thought I'd try to step up the stretching traction, and VED first - Franklin had said I could come in any time to be checked anyway. I found that daily use of both traction and VED made my erections stronger. My penis looked better, veins bulging and looking stronger. And I could actually maintain an erection at last.

Anyway, it worked for me and today I'm pretty much back to what I was. Your dick will never look or feel quite the same after surgery. But everything works like it should and I'm still straight.  

Hrvat21

Did you restore your pre peyronie's size?

DELETED

Quote from: lessor on December 21, 2017, 03:07:18 PM
I am almost sure it is almost impossible get lenght augmentation without implant plus sliding technique.
Why? I mean, If someone will perform circular tunical incision with graft which is just slightly longer than incision and without implantation of prosthesis, will there be a small chance of increase erect length?

Jonbinspain

Hrvat;

Yes, mostly. As I never really took pre Peyronie's measurements I don't know my exact previous size - although an old girlfriend said 6.5" with a quick measurement.

I haven't measured, but I'm a good 6", maybe a tad over. So I'm possibly 1/4 - 1/2" down.

I still use traction 3-4 days a week as it helps me maintain strong erections, so it's possible I could get that small amount back too.

After this type of surgery gentle manual stretching and traction are essential to prevent grafted tissue from retracting.