Peyronie’s disease is characterized by the formation of tough, non-elastic scar tissue, or plaque, within the tunica albuginea, the fibrous sheath surrounding the erectile bodies of the penis. This plaque prevents the tissue from expanding normally during an erection, resulting in a noticeable bend, indentation, or shortening of the penis. The resulting deformity can cause pain during erection and often makes sexual intercourse difficult or impossible, significantly affecting a person’s quality of life. Surgery is typically reserved for men whose disease has stabilized and whose deformity prevents satisfactory sexual function.
Criteria for Surgical Intervention
The decision to pursue surgery for Peyronie’s disease is made after assessment of the disease phase and functional impact. The condition must have entered the chronic, or stable, phase, which is defined as no change in curvature or symptoms for at least six to twelve months, and the absence of painful erections. Operating before this stability is achieved risks recurrence or an unsatisfactory result as the disease may continue to progress post-surgery.
The severity of the penile curvature is a determinant, with surgery usually considered for deformities greater than 30 to 45 degrees that interfere with penetration. Concurrent erectile dysfunction (ED) that does not adequately respond to oral medications is another strong indication, as the chosen surgical approach must address both the curvature and the inability to achieve sufficient rigidity. Surgery is considered after non-surgical treatments, such as intralesional injections or oral medications, have failed to produce a functionally acceptable outcome. Patients must also have realistic expectations, understanding that the goal is functional straightness, generally defined as a residual curvature of 20 degrees or less, rather than a perfectly straight penis.
Detailed Overview of Surgical Procedures
The choice of surgical procedure depends on the severity of the curvature, the presence of erectile dysfunction, and the patient’s existing penile length. The three primary categories of surgery—plication, grafting, and prosthesis implantation—are designed to address different clinical scenarios.
Plication procedures, such as the Nesbit or 16-dot techniques, are typically recommended for men with good erectile function and a less severe curvature, often less than 60 degrees. This technique involves shortening the side of the penis opposite the plaque, the convex side, by placing non-absorbable sutures in the tunica albuginea. This equalizes the length discrepancy between the scarred and healthy sides, effectively straightening the shaft. While effective for correction, plication procedures inevitably result in some degree of penile length loss, which can range from a few millimeters to over a centimeter.
For men with severe curvature, typically greater than 60 degrees, or those with complex deformities like a severe hourglass narrowing, grafting is preferred. This approach aims to restore length by surgically opening or removing the constricting plaque. The resulting defect in the tunica albuginea is then covered with a graft material, which can be synthetic, animal-derived, or patient-harvested tissue. Grafting requires the patient to have strong native erectile function, as the procedure carries a greater risk of post-operative erectile dysfunction compared to plication.
Penile prosthesis implantation is the primary treatment when Peyronie’s disease is complicated by severe erectile dysfunction that has not responded to medical therapy. This procedure addresses both the rigidity issue and the curvature simultaneously. An inflatable or malleable device is surgically placed into the erectile chambers, providing sufficient hardness for intercourse. The prosthesis itself often straightens the penis, but if a residual bend remains, the surgeon can perform manual modeling or an adjunctive procedure like plication or grafting at the time of implant. This combined approach offers the highest satisfaction rates for men dealing with both significant curvature and ED.
Post-Operative Recovery and Care
Recovery focuses on minimizing swelling, managing pain, and allowing the surgical sites to heal. Patients are typically sent home with a compression dressing that remains in place for the first 24 to 48 hours to reduce bruising and swelling. Oral pain medication is prescribed to manage discomfort, which may feel more pronounced during involuntary nocturnal erections in the first few days.
Resumption of normal, non-strenuous daily activities is usually possible within a few days to a week, but heavier lifting and strenuous exercise are restricted for at least two to four weeks. Sexual activity, including masturbation, is prohibited for a longer period, typically four to eight weeks, regardless of the procedure, to ensure complete wound healing and integration of any internal sutures or grafts.
Penile rehabilitation often begins a few weeks after the operation. This regimen includes gentle manual stretching, the use of a vacuum erection device, and sometimes the use of phosphodiesterase type 5 inhibitors (PDE5i) to encourage strong erections. This rehabilitation is thought to help maximize the final penile length, prevent scar contracture, and promote tissue health following the surgery.
Long-Term Functional Outcomes
Long-term success is measured by the ability to engage in satisfactory sexual intercourse, which is achieved in the majority of cases. Most procedures aim for a final residual curvature of 10 to 20 degrees, which is considered functionally straight and allows for pain-free penetration. Patient satisfaction following penile prosthesis implantation is often the highest, ranging from 86% to 90%, due to the reliable rigidity and curvature correction it provides.
The potential for penile length loss, particularly with plication, is a common concern post-operatively. While grafting procedures are designed to maintain or even increase length, the actual gain can be modest, and some studies report significant patient dissatisfaction with length, even when the curvature is corrected. A small percentage of men may experience a recurrence of curvature or new-onset erectile dysfunction, particularly after grafting.
Changes in penile sensation, often described as reduced feeling in the tip of the penis, can occur, especially with more extensive grafting procedures. This sensory change is usually temporary, resolving within a few months, but in rare instances, it can persist. Regular follow-up appointments are necessary long-term to monitor for any recurrence, assess functional results, and ensure the integrity of the surgical repair.