Peyronie’s Disease (PD) is characterized by the formation of non-cancerous scar tissue, or plaque, within the tunica albuginea, the fibrous sheath surrounding the erectile chambers. This internal scarring prevents the tissue from stretching properly during an erection, causing a noticeable curvature, shortening, or deformity that can make sexual intercourse difficult. This article covers the surgical procedures used to correct PD and the less common scenario where PD develops following an unrelated urological operation.
Surgical Procedures for Peyronie’s Disease
Surgical intervention for Peyronie’s disease is generally reserved for patients whose condition has entered the chronic, stable phase. This means the pain has subsided and the curvature has not changed for at least three to six months. The choice of procedure depends on the severity of the curvature, the presence of penile shortening, and the quality of the patient’s erectile function. The goal is to achieve a straight penis that allows for successful sexual activity while preserving erectile capability.
One primary approach is penile plication, a shortening procedure where sutures are placed on the side of the penis opposite the plaque to correct the bend. Plication is recommended for men with a curvature of less than 60 degrees who have retained adequate penile length and firm erections. This technique is less invasive and does not involve incision or removal of the PD plaque, helping minimize the risk of new erectile dysfunction.
The alternative approach is grafting, a lengthening procedure that involves incising the plaque to release tension and covering the resulting defect with a tissue graft. Grafting is reserved for more severe deformities, curvatures greater than 60 degrees, or complex deformities. While grafting aims to restore lost length, it is more complex and carries a higher risk of complications, including changes to erectile function. A third option is the insertion of a penile prosthesis, often combined with plication or grafting, which is recommended when PD is accompanied by severe, treatment-resistant erectile dysfunction.
Immediate Post-Operative Expectations and Recovery
The immediate recovery period focuses on managing swelling and pain while ensuring the surgical site heals properly. Most procedures are performed on an outpatient basis, allowing patients to return home the same day, though observation is common. Patients can expect mild to moderate discomfort, which is managed with prescription or over-the-counter pain medication.
A compressive dressing is applied immediately after the operation to reduce swelling and bruising, and is usually removed within one to five days. Patients should keep the area clean and can typically begin showering one day after removing the initial dressing. Return to non-strenuous, desk-based work is often possible within two to five days of the procedure.
The most important recovery instruction is mandatory abstinence from all sexual activity, including masturbation, for four to eight weeks, with six weeks being the common recommendation. This time is necessary to allow internal sutures and repaired tissues to heal completely and secure the curvature correction. Premature sexual activity risks tearing the internal repair, which could lead to recurrence of the curvature.
Post-operative penile rehabilitation protocols are often initiated shortly after surgery to optimize the final result. These protocols frequently involve using a vacuum erection device (VED) or a penile stretching regimen, typically starting two weeks after the operation. The goal is to promote circulation, stretch the tissue to prevent shortening, and maintain the corrected length.
Potential Complications and Long-Term Outcomes
Patients undergoing surgical correction should maintain realistic expectations regarding long-term outcomes, as trade-offs are common. Residual curvature is possible, meaning the penis may not be perfectly straight, though the goal is generally to achieve a curvature of 20 degrees or less, which permits intercourse. Long-term studies indicate that significant curvature recurrence can occur in a minority of patients, sometimes reaching over 20% after several years.
Changes in penile length are a significant long-term consideration. Although grafting procedures are designed to lengthen the penis, many patients still report a subjective feeling of shortening. Plication procedures inherently shorten the penis by operating on the long side, and studies show most plication patients experience some degree of measured or perceived length loss.
The risk of developing new erectile dysfunction (ED) is present, with higher rates reported following grafting procedures compared to plication. Furthermore, some men experience transient or permanent changes in sensation, such as numbness or reduced feeling in the glans. This can be a consequence of manipulating the neurovascular bundle during the operation. Overall patient satisfaction with the cosmetic appearance and functional outcome can vary, making thorough pre-operative counseling important.
Peyronie’s Disease Development After Non-PD Procedures
The development of Peyronie’s disease following a procedure not intended to treat PD, such as a radical prostatectomy (RP) for prostate cancer, is a distinct scenario. Studies suggest the incidence of new PD following RP is significantly higher than in the general population, with reported rates around 15 to 16%. This new onset typically presents within one to three years after the prostate surgery.
The exact mechanism is not fully understood, but one theory suggests that prolonged compromised blood flow and oxygen deprivation (hypoxia) to the penile tissues following RP contributes to fibrotic plaque formation. Nerve damage or vascular injury during the pelvic surgery may also initiate tissue scarring. Management of this new PD generally begins with the same non-surgical therapies used for standard PD, such as intralesional injections and stretching devices.
For men who develop severe curvature or significant underlying erectile dysfunction after prostate surgery, surgical treatment often involves placing a penile prosthesis. Combining the implant with a straightening maneuver, like plication or grafting, addresses both the erection difficulty and the curvature in a single procedure. This combined approach is frequently the most effective way to restore function and geometry for men with PD that develops after RP.