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Peyronies Disease TREATMENT Discussion Boards => Surgery for Peyronie's Disease => Topic started by: LWillisjr on April 10, 2013, 07:33:42 PM

Title: Exactly What is the Difference Between Nesbit, Plication, Excision, and Graft?
Post by: LWillisjr on April 10, 2013, 07:33:42 PM
Nesbit is plication surgery. Different doctors use a different pattern on how to place/weave the stitches. 6-dot, 12-dot, etc. But it is all the same principle of using stitches to pull the long side of the Tunica in to make your erection align with the short side.
Title: Re: Re: my experience with congenital curvature, pre op and post op.
Post by: notanymore on April 10, 2013, 08:50:34 PM
i was under the impression that nesbit involved removal of some of the tunica on the long side and then stitched together and plication didnt involve any removal of tunica. honestly, you guys probably know more.
Title: Re: Re: my experience with congenital curvature, pre op and post op.
Post by: notanymore on April 10, 2013, 08:58:07 PM
Plication corporoplasty versus Nesbit opera... [Int Urol Nephrol. 2012] - PubMed - NCBI (http://www.ncbi.nlm.nih.gov/pubmed/21559790)
Title: Re: Re: my experience with congenital curvature, pre op and post op.
Post by: Hawk on April 10, 2013, 09:01:11 PM
NO, Nesbit is a classic plication procedure and it was always called a Nesbit Tuck.  Then everyone thought plication sounded more complex and professional so it was called a Nesbit plication.  It is NOT an excision were any material is removed.  Other than your link I have never in 8 years heard of excision and Nesbit ever used in connection with each other and I have read first hand accounts by doctor Levine that has done the Nesbit almost from the beginning.
Title: Re: Re: my experience with congenital curvature, pre op and post op.
Post by: keepitstraight on April 11, 2013, 07:44:49 AM
To clarify Nesbitt technique indeed involves tunical excisions (this was the principle described by Nesbitt and still used). If you read medical literature you will find it. And also if you ask a urologist he will agree.

Plication is the most general term that embraces different approaches and can be subdivided in three subcategories, one is excision (nesbitt, modified nesbitt,...), the other is incision (Levines TAP procedure, Yachia Technique, etc...) and there is a third one that does not involve excision or incision like for example 16-dot technique by Dr. Tom Lue.
To be honest i think the term plication is a bit misleading sometimes because it means "folding" something. Hawk mentioned another similar term Tucking.

Then you have the grafts variants, like excision and graft, incision and graft.

I hope it helped
Title: Re: Exactly What is the Difference Between Nesbit, Plication, Excision, and Graft?
Post by: LWillisjr on April 11, 2013, 07:32:30 PM
I think you are confusing different surgical procedures. Levine describes all three in his TAP paper. He mentions that TAP (plication) is optimal for men with rigid erections and curves less than 60 degrees. His next sentence then states that for more complex curves that plaque incision (scoring the plaque so that it can expand), or excision with grafting (removing the plaque and replacing it with natural or synthetic graft material) are other choices.

Plication by definition is the folding in and suturing of tucks, so as to tighten weakened or stretched tissue ref:www.dictionary.com (http://www.dictionary.com). I do agree that there are various suture techniques to tuck the Tunica, but all are considered plication (tucking the Tunica on the long side) and has nothing to do with incision or excision. In fact plication is done on the NON-plaque side while incision/excision and grafting is done on the side where the plaque is located.

Plication techniques are considered less invasive procedures, while incision or excision and grafting procedures are considered more invasive techniques.
Title: Re: Exactly What is the Difference Between Nesbit, Plication, Excision, and Graft?
Post by: keepitstraight on April 12, 2013, 05:31:17 AM
Sorry i was not considering incision or excision with graft in the plication group. They are another approach. My bad.

In any case plication do indeed or can involve excision or incision (actually if you read Dr. Levines article in the book peyronie management his TAP procedure is based on superficial incisions of the tunia). Actually Dr. Levines technique have some similarities with the Stage technique from Dr. Paulo Egydio and Dr. Franklin Kuehhas in which only the outer layer of the tunica is incised/excised.
Title: Re: Exactly What is the Difference Between Nesbit, Plication, Excision, and Graft?
Post by: Tim_B on November 03, 2013, 09:21:05 AM
hey guys
here is a link to the original publication on the stage technique.
it may help.
Superficial tunica albuginea excision, using geometr... [BJU Int. 2012] - PubMed - NCBI (http://www.ncbi.nlm.nih.gov/pubmed/22788740)