Peyronie’s graft surgery—tips and tricks from the masters in andrologic surgery

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Pfract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583062/

Here it is guys.... a super recent article from the master Laurence Levine, so well known in this board, on grafting and peyronies surgery. A very good read, in my opinion.

Of particular notice:

"Results

Adequate preoperative counseling of patients is crucial, and should include possible adverse effects and negative outcomes, such as persistent or recurrent curvature, diminished sensation at the glans penis, diminished erectile function, or penile shortening. The correct indication for a grafting technique is imperative. There are many surgical details during grafting techniques, which have to be considered in order to achieve the best result possible. These include the correct preparation of the neurovascular bundle, the following partial plaque excision without damaging the underlying erectile tissue, and the sufficient closure of the resulting tunica albuginea defect. Defect closure can be done by grafts like pericardial graft (PEG procedure) or the collagen fleece (Sealing technique). Postoperatively, the patient should refrain from sexual activities for at least 6 weeks, and follow a penile rehabilitation program with Phoshodiesterase-Type-5 inhibitors, manual stretch, penile massage, and penile traction therapy."


Jonbinspain

Pretty much what has always been said, no penile surgery comes without a significant degree of risk. Yes the risk can be reduced or minimalised by using a top surgeon, but the risks will always be there - for the foreseeable future anyway.

I had some grafting wiith my surgery and can confirm a slightly reduced sensation in the glans.
Some initially reduced erectile function - which I've now recovered from with extensive use of traction and VED. And, yes, I'm still slightly down on size - maybe 1cm.

The trade off for me was that surgery was a relatively risk free bet. My Peyronie's had developed to the point where I couldn't have sex. I'd tried everything and anything before settling for surgery ( Xiaflex was not considered a viable option in my case).

Your dick will never feel exactiy as it did after surgery. But for me I have a straight, functional penis, which in the circumstances was probably the best I could hope for.  

Hrvat21

How different is your dick after surgery? Can you still use it without having to be careful? And do you think you will get back to pre peyronie's size through traction. Also did you have hourglassing?

JohnWright

a) I'm at the 18th month post surgery, and my dick works AMAZING. I have mind blowing sex. I couldn't be happier, and I would make the decision to have surgery again in a heartbeat. One of THE best decisions I've ever made. I do not have hour glassing. My dick is slightly thicker in the lower half from the effect of the plications pulling on the long side -- this has been a surprising uptick in my overall experience and visual satisfaction. The increase in thickness was absolutely apparent to my wife. "Wow!"

b) There is risk in all surgeries to any part of the body -- not just the penis. And, surgery to the penis doesn't carry a significant degree of risk -- as a general statement. All surgeries have risk. And, the risks vary from patient to patient, as well.

For example, hernia surgery: I researched the hell out of regional surgeons who do hernia ops. I ended up selecting a surgeon who is two hours away from me even though there are 30 surgeons all along the road from here to there. I obtained 100% satisfaction with zero complications. My friend who didn't do research, not so much. After 14 months he is miserable.

Every surgery has risks. The risks vary for every surgery. With any surgery, and with any specific patient, the risks can be higher, or lower. Lots of factors.

Look for data that has facts behind it. Mark emotional rhetoric as just that -- emotion.



TonySa

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

Your dick just feels different. I'm not the first to say this. Don't get me wrong, it works fine, but it somehow doesn't feel the same as it did before Peyronie's.

Of course all surgery carries risks. Especially any surgery carried out under general anaesthetic. To be clear about risk, when I say the risk is significant, I mean of the surgery not working. I don't mean that penile surgery carries a greater risk to the patient. But that a satisfactory outcome is more difficult to achieve. That's because of the complex nature of the penis.  

Jonbinspain

Tsanchez;

I had a severe curvature - close on 90 degs at the apex of the curve - probably 70 degs overall. Plus the plaque was calcified.

Kuehhas told me I would need four rounds of Xiaflex and that the best I could hope for was about a 35 deg improvement in the curvature. On top of that the cost wasn't that far off the cost of surgery. He said he'd do it if that's what I wanted but wouldn't recommend it in my case.

Plus there's this. When Xiaflex was first approved I wrote to the manufacturer and asked them if it was likely to work on my calcified plaque. Their response was that they didn't know because no patients with calcified plaque had been included in their trials. Surprise.!  

Pfract

I agree Jonbin... but one thing is when WE say it here by experience, the other is having a paper from a top doctor, confirming it. Because, a Dr. like him, super respected worldwide, is able to influence other doctors too, on the best approach, which in turn improves outcomes for other patients too!

With all of this, i am thinking about seeing Dr. Landon Trost, of Mayo clinic, to talk to him about the Restorex device and for help on using it, before going for the implant, in the future.