Peyronie’s Disease (PD) is characterized by the development of fibrous scar tissue, known as a plaque, within the lining of the erectile tissue of the penis. This plaque causes the penis to curve or bend during an erection, often leading to pain and difficulty with sexual intercourse. The condition can also result in penile shortening or narrowing, significantly impacting a man’s quality of life. For men whose condition is severe and unresponsive to conservative methods, surgical intervention becomes the definitive treatment option.
Criteria for Surgical Intervention
Surgery is not the first course of action for Peyronie’s Disease; it is reserved for specific patient profiles. A primary requirement is that the disease must be in the chronic or stable phase, meaning there has been no change in the degree of curvature or plaque size for a minimum of three to six months, and pain has resolved. The disease usually stabilizes between 12 and 18 months after the initial onset of symptoms.
If the disease remains active, surgery is not recommended because the outcome could be compromised by ongoing scar formation. Beyond stability, a patient must experience a functional impairment, meaning the curvature is severe enough to prevent or significantly hinder penetrative sexual activity. The degree of curvature, often determined during an induced erection, is a major factor in determining the appropriate surgical technique. Patients may also be considered for surgery if non-surgical treatments, such as injection therapies, have failed to provide adequate functional correction.
Specific Surgical Procedures
The choice of surgical procedure depends heavily on the degree of curvature, the length of the penis, and the quality of the patient’s natural erections before the operation. Three main surgical strategies are employed to correct the deformity, each achieving penile straightening through a different mechanism. The least invasive approach involves tunical shortening, while more complex procedures focus on tunical lengthening or prosthetic implantation.
Plication Procedures
Plication procedures are recommended for men with moderate curvature, typically less than 60 degrees, who maintain excellent erectile function. This technique involves placing permanent, non-absorbable sutures on the side of the penis opposite the plaque (the convex side) to create a tuck. By shortening the unaffected side, the procedure straightens the penis. An expected outcome is some degree of penile length loss, though it is often minimal and balanced by the quick recovery time.
Grafting Procedures
Grafting, or tunical lengthening, is the preferred choice for severe curvatures exceeding 60 degrees, or when the patient has significant penile shortening or complex deformities like hourglass narrowing. This technique involves incising or partially removing the plaque to release the tension causing the bend. The resulting defect in the tunica albuginea is then covered with a biological or synthetic graft material. The goal is to maximize the preservation of penile length, though it is a more complex operation than plication. Patients must have satisfactory erectile rigidity prior to the procedure, as this approach does not address underlying erectile dysfunction.
Penile Prosthesis Implantation
The implantation of a penile prosthesis is reserved for men who experience both Peyronie’s Disease and concurrent erectile dysfunction unresponsive to medical treatments. The prosthesis, usually an inflatable device, provides the rigidity necessary for intercourse and allows the surgeon to straighten the penis. Straightening is often achieved by inflating the device and manually modeling or bending the penis over the cylinders to break the plaque (manual modeling). If a significant residual curve remains, additional procedures like plaque incision may be performed to achieve a functional result.
Surgical Risks and Potential Complications
While surgery offers reliable correction, patients must be aware of potential complications. Penile shortening occurs to some degree in nearly all forms of PD surgery. Although much of the length loss is caused by the disease itself, plication procedures inherently result in a measurable decrease in length because the unaffected side is shortened. Grafting procedures aim to preserve length, but the ultimate outcome can still result in perceived shortening.
The risk of developing new or worsened erectile dysfunction (ED) is a possibility following any penile straightening procedure. Even in patients with excellent pre-operative function, the trauma of surgery and changes to the penile structure can compromise the ability to achieve or maintain a rigid erection. Studies indicate that the risk of post-operative ED can range widely and may increase over a longer follow-up period.
Recurrence of the curvature is a complication if the original disease process continues or if the surgical correction fails. Grafting procedures carry a risk of recurrent deformity due to graft contracture or failure. A change in penile sensation, particularly a loss of sensitivity in the glans, can occur. This complication is often temporary but can persist in a small percentage of patients. Like any operation, there is a risk of infection, bleeding, or the formation of a hematoma (a collection of blood under the skin).
Post-Operative Recovery and Expectations
The recovery timeline varies significantly based on the procedure, with plication offering the quickest return to normal activities. Most patients can resume light daily activities within a few days and return to work within a week following plication. The initial post-operative period is marked by swelling and bruising, which gradually subside over several weeks.
A longer recovery is expected after grafting procedures, which are more complex and involve extensive tissue manipulation. For any procedure, the most significant restriction involves sexual activity, which must be avoided for a defined period to allow for complete internal healing. Surgeons advise refraining from sexual intercourse or masturbation for a minimum of four to eight weeks, depending on the extent of the surgery.
Post-operative penile rehabilitation is often recommended to optimize results, especially following grafting procedures. This may involve stretching exercises or a vacuum erection device, which applies gentle negative pressure to promote blood flow and tissue expansion. Patients are advised to use a scrotal support garment to minimize swelling and must avoid immersing the wound in water (baths or swimming pools) for two weeks to prevent infection.