Peyronie’s disease occurs with inflammation of the membrane surrounding the penis, called tunica albigunea; It is a progressive, chronic and difficult to manage disease.
Tunica albuginea has 3 basic functions
Determining erect penis size
Allowing the penis to stretch to a certain point
To ensure high pressure formation during hardening.
Therefore, the main findings seen in Peyronie’s disease are;
Plaque formation in the penis
erectile dysfunction
Pain (especially in the early (acute) stage)
penis curvature
Deformity of the penis
penis shortening
When is Surgical Treatment Necessary in Peyronie’s Disease?
Peyronie’s disease basically consists of two stages. The first 6-12 months of the disease are called the acute phase. During this period, the disease is still in its progression phase. Pain is evident. Therefore, surgical treatment should never be performed. It should be waited for the disease to reach the chronic stage because interventions at this stage may cause the disease to worsen. During this period, patients should receive shock wave therapy. Click to get information about shock wave therapy.
Once the disease reaches the chronic stage, surgical treatment may be considered. There are two basic questions we ask patients while treating them at this stage;
- Do you have a curvature?
- Do you have erection problems?
Treatment is planned for patients according to the answers to these questions. Penis curvature basically occurs because one of the surfaces of the penis is shorter than the opposite. To eliminate this size difference, geometrically either an addition is made to the shorter side or a piece is removed from the longer side. There are basically two surgical techniques.
- Penile plication (Nesbit method): It is the appropriate technique if the curvature of the penis is between 30-60 degrees. The basic principle of surgery is to obtain a geometrically flat shape by removing a piece from the long side. The most important side effect is shortening of penis length. There is no risk of erection problems after this technique.
- Incision venous patch: This is a surgery that should be performed when the penis curvature is 60 degrees or above. This technique can also be applied in patients with a 30-60 degree curvature if height loss is worried. During surgery, vascular patches are added to the short edge. These patches can also be created from veins taken from people’s legs; Biological ready-made materials can also be used. The most important problem with this technique is the risk of developing erectile dysfunction afterwards. If the patient’s erectile capacity is low before surgery, the erection problem may deepen. For this reason, penile prosthesis surgery should be considered in patients with erectile dysfunction and advanced curvature.
If there is erectile dysfunction in Peyronie’s disease and there is no response to other treatments, penile prosthesis surgery is an important treatment option. You can find detailed information about penile prosthesis here.
Peyronie’s surgery can be combined with penis lengthening and thickening surgery.
It is very important to make personalized planning for each Peyronie’s patient. You can choose the one that is most suitable for you from the scenarios I will roughly write below and get an idea about the right treatment.
No curvature or below 30 degrees, no erectile dysfunction:
You can be followed in your current state. Some drug treatments may be started. There is no need for surgical treatment.
Curvature is between 30-60 degrees, no erectile dysfunction:
Curve corrective surgery should be performed. If the patient is worried about losing length in his penis, the incision venous patch technique should be applied.
Curvature is between 30-60 degrees, there is erectile dysfunction:
If erectile dysfunction has developed in Peyronie’s patients, the correct approach is to solve both the erectile dysfunction and the curvature with a penile prosthesis. Penile prosthesis+Nesbit surgery and incision venous patch surgery give satisfactory results in these patients.
Curvature over 60 degrees, no erectile dysfunction:
The most appropriate approach in these patients is incision venous patch surgery. It should not be forgotten that erection problems may develop after surgery.
Curvature over 60 degrees has erectile dysfunction:
The most complex Peyronie’s disease is observed in this group. The most appropriate approach for these patients is the combination of penile prosthesis surgery and incision venous patch technique.
