Peyronie’s disease could be defined as a series of penile symptoms that includes penile pain, length loss, curvature, fibrous plaque and eventually sexual dysfunction. The various treatment options depend on the duration of symptoms, extent of penile curvature, hour-glass deformity, size of penile plaque and erectile dysfunction. Penile curvature may reoccur again owing to abnormalities in the underlying penile tissue. However, it can be corrected with the help of surgery.
Generally, patients who do not respond to drug therapy for Peyronie’s disease and who have penile curvature that persists for more than 12 months are regarded as ideal candidates for surgical intervention. All patients considered potential candidates for surgical reconstruction are required to undergo vascular evaluation to determine if the patient’s erectile function is adequate. The surgical procedure is chosen for the individual patient depending upon the preoperative erectile function. The vascular test of choice may either be dynamic infusion cavernosometry/cavernosography (DICC) or duplex Doppler penile ultrasonography (DUS).
The corrective operation is selected primarily on the basis of certain criteria such as preoperative erectile function, preoperative erectile length, the degree and complexity of the curvature and the expectations and goals of patient as well as partner.
There are 3 main types of surgical procedures for Peyronie’s disease.
Penile plication surgery
Penile Plication Surgery normally involves performing a tuck procedure on the region opposite to the plaque. This helps to shorten the long side of the penis. Some of the main benefits of this procedure include its simplicity, preservation of preoperative erection ability, and a high degree of patient satisfaction. The disadvantages basically include loss of penile length. Patients who are regarded as ideal candidates for this procedure include those who have sufficient penile length and a simple curvature without any related abnormalities.
Plaque incision/excision and grafting
Plaque incision/excision and grafting is a series of procedures that primarily involves the full or partial excision of the plaque or its incision with the positioning of a graft in the space created by the excision or incision technique. Multiple graft materials are generally used in this process including dermis, cadaveric fascia, cadaveric pericardium, saphenous vein and intestinal submucosa. Suitable candidates for this approach are men who have shorter penile length and have normal erectile function irrespective of the degree or severity of curvature and men who have hour-glass deformity or waisting. Some of the main disadvantages include the development of postoperative erectile dysfunction in men who have weak erectile function and loss of penile sensation.
Penile implant or Penile prosthesis enables urgent correction of the penile curvature as well as fully rigid erections. A prominent benefit of penile implants is the high degree of postoperative patient satisfaction and low incidence of risks and complications. Penile prosthesis is generally recommended for men who have erectile dysfunction as well as penile curvature.
Some of the common postoperative risks include:
- Skin irritation
Some of the serious complications include
- Temporary decrease in the sensation to the glans of penis
- Penile shortening
- Urethral injuries
- Erectile dysfunction
- Recurrence of penile curvature