Congenital Penile Curvature Surgery

The penis is one of the most important actors in the urinary system and sexual intercourse. The penis must have certain properties to properly function. However, in some cases, this organ might have a down, up, right, or left curvature. An erect penis must be perpendicular to the body at 90 degrees. Irregularities in curvature might occur from birth or due to disease, trauma, or surgical interventions.

In general, curvature up to 30 degrees is not a symptom of an issue, and treatment is not necessary. However, curvature beyond 30 degrees might cause problems and pain during sexual intercourse, and these cases require treatment. In particular, congenital penile curvature needs treatment.

What is Penile Curvature? Why Does This Happen?

Under normal circumstances, the erect penis is perpendicular to the body at 90 degrees. A down, up, right, or left curvature of the penis is referred to as penile curvature. Penile curvature is divided into two types: congenital and acquired (Peyronie’s Disease).

1. Congenital penile curvature: There are two spongy tissues (corpus cavernosum) formed by vascular structures that create an erection, and one spongious tissue houses the urinary tracks(urethra) in the penis. Developmental anomalies during pregnancy are one of the most common causes of congenital penile curvature. Additionally, hypospadias, which is defined as a urinary meatus being lower than it should be, might also cause congenital penile curvature. Hypospadias is a developmental problem of the spongious tissue inside the urinary tract, and the penis often has a downward curvature.
2. Acquired penile curvature: The shape disorders in this group often occur at a later age, and these are often caused by Peyronie’s disease. Peyronie’s disease refers to calcification between the spongy tissue necessary for an erection and the outer sheath. The disease demonstrates symptoms in the form of pain at first and shape anomalies later.

What are the Treatment Methods for Penile Curvature?

Congenital penile curvature requires surgical treatment. This disease can be treated during childhood before the penis reaches sufficient length. The treatment method for Peyronie’s disease depends on whether the disease is in the acute or chronic period.

Medication is used to treat acute Peyronie’s disease. Medication can yield results since plaque formation hasn’t yet started. Additionally, alternative support practices, such as collagen synthesis inhibitor injection and shock therapy, might also yield positive results.

The medication might be ineffective at the chronic stage in which the pain ends, and shape disorder begins. Although injection and shock therapies have benefits, surgical methods are necessary for treatment.

What is Congenital Penile Curvature Surgery?

The reasons for congenital penile curvature are still unknown. This problem, which is often caused by developmental anomalies in the antenatal period, does not cause any additional dysfunction. However, if the curvature is greater than 30 degrees, causing sexual intercourse difficulties, or if an individual has aesthetic concerns, penile curvature treatments might be requested.

For these patients, practices such as medication, local gels, or shock therapy will be ineffective. The only effective treatment method is surgery. Individuals who want congenital penile curvature surgery often have a longer penis size.

For surgical methods, plication contralateral to the less developed size and penis shortening techniques, such as Nesbit, is applied. In the case of hypospadias, the urinary meatus is moved to the original location. The operation is relatively easy, as the hole is closer to the tip of the penis. Congenital penile curvature surgeries have an 85% success rate.

How is Congenital Penile Curvature Surgery Performed?

Congenital penile curvature surgery is classified as a simple surgical intervention. The operation takes between 30 minutes and 2 hours, and the important thing during the operation is to be careful about the vein and nerve structure of the penis and to avoid blood flow problems.

In congenital penile curvature surgery, devices such as microscopes and loops are used, which enable surgeons to view the penis structure during plication and graft surgery. If grafts are necessary for patients without erectile dysfunction, there might be erection problems if the vein and nerve structure are damaged. Therefore, a specialist must perform the operation carefully. In cases of congenital penile curvature, the length of penis is adjusted according to the shorter side.

In hypospadias surgery, the urinary meatus is moved to the most suitable location. The curvature is also corrected in this operation. For curvature above 15 degrees, Nesbit, tunica albuginea plication, and 16-point plication surgeries are performed.

The success rate for these operations is above 90%. The operation is performed under anesthesia, and patients are hospitalized for 1 day. Patients can have sexual intercourse 1.5 months after surgery, and a follow-up examination is done 10 days after the surgery.

Who is Suitable for Surgery?

Congenital penile curvature can have both physical and psychological effects. Although there is no dysfunctionality, this problem might decrease self-confidence and lead to sexual health problems. A suitable candidate for congenital penile curvature surgery is identified through a specialist andrologist examination.

In general, penile curvature above 30 degrees must be treated, since such curvature causes problems during sexual intercourse. Patients must be individually examined before the operation, expectations from the treatment must be identified, and suitable treatment must be planned. Accordingly, individuals with good general health and the following issues are eligible for surgery:

• Penile curvature above 30 degrees,
• Hypospadias,
• Individuals who cannot have sexual intercourse due to penile curvature,
• Individuals who experience self-confidence problems due to penile curvature.

Will the Penis Become Shorter After Surgery?

During congenital penile curvature surgery, the penis size is adjusted in favor of the shorter side. The penis might be shortened during the operation, especially to correct curvature around 60 degrees. However, this won’t be visible shortening.

There might be penis shortening, numbing, erectile dysfunction, and relapse curvature after penile curvature surgery, and the patient must be informed about these possible negative outcomes. Penile shortening after surgery can be treated with a vacuum application, which can start 1 month after the operation.

To prevent penile curvature relapse, alternative treatments to prevent night erection can be followed after surgery. Also, avoiding sexual intercourse for 6 weeks is important. To minimize these complications, the surgery must be performed by an experienced surgeon.