The Nesbit procedure corrects abnormal penile curvature caused by Peyronie’s disease. Peyronie’s disease involves fibrous scar tissue (plaque) forming within the tunica albuginea, the sheath surrounding the erectile tissue. This plaque restricts expansion on one side, causing the penis to bend during an erection. The goal is functional straightening to allow for satisfactory sexual intercourse. This is accomplished by shortening the healthy side of the penis opposite the plaque, counteracting the bend. The procedure is a form of plication surgery that balances the length of the two sides of the penile shaft.
Treating Peyronie’s Disease: Patient Selection
Selecting the appropriate candidate focuses on the stability of the disease and the patient’s baseline penile length. The plaque must be stable, meaning there has been no progression in curvature or pain for at least six months. Operating during the acute phase of Peyronie’s disease is avoided because the curvature can still change.
The procedure is most suitable for men with a curvature less than 60 degrees, although some sources suggest it is effective for curves up to 40 or 45 degrees. The patient must have sufficient erect penile length to tolerate the expected shortening that results from the surgery. This is because the procedure straightens the penis by making the long side match the short side, inherently causing a length reduction. Furthermore, the patient must have adequate erectile function, as the Nesbit procedure is not designed to correct severe erectile dysfunction.
Surgical Mechanics of the Nesbit Procedure
The Nesbit procedure is an excisional corporoplasty involving the removal of tissue for correction. The procedure begins with the surgeon inducing an artificial erection to precisely identify and mark the maximum point and degree of the curvature. This step ensures accurate planning by revealing the true extent of the deformity.
The surgeon then exposes the tunica albuginea, typically through a circumcising incision. Small, elliptical segments of the tunica albuginea are excised from the convex side of the penis—the longer, unaffected side—opposite the plaque. This excision shortens the long side.
Once the segments are removed, the surgeon closes the resulting defects with non-absorbable sutures, effectively creating a tuck or plication. This closing action draws the tissue together, shortening the outer side and straightening the penile shaft. A final artificial erection is performed before closing the incision to confirm that the desired straightening has been achieved.
Expected Post-Surgical Results
The Nesbit procedure is a successful intervention for correcting penile curvature, offering reliable long-term outcomes. Over 80% of patients achieve complete or near-complete straightening, defined as a residual curvature of 20 degrees or less. This correction is sufficient to restore the ability to engage in satisfactory sexual intercourse.
Patient satisfaction rates following the Nesbit procedure are high, reported to be over 85%. Correction of the physical deformity often leads to improved overall sexual function scores. Patients are advised to refrain from sexual activity for a period of about four to eight weeks to allow for adequate healing of the surgical site. Most patients can resume normal non-strenuous activities within a week of the operation.
Potential Side Effects and Complications
The most significant consequence of the Nesbit procedure is a reduction in erect penile length. Since the technique shortens the longer side to match the shorter side, length loss is an expected outcome that patients must be counseled about pre-operatively. The shortening typically ranges from 1 to 3 centimeters, depending on the degree of correction required.
Other potential side effects include temporary changes in penile sensation, such as mild numbness of the glans penis, which resolves within a few weeks to months. Patients may also feel the sutures or knots under the skin, described as small, palpable bumps. Other risks include insufficient straightening, recurrence of the curvature, or developing a painful hematoma.