Surgical Treatments for Peyronie’s Disease 

Penile curvature is a problem that can hinder the sexual lives of men. While an erect penis must have a 90-degree perpendicular angle to the body, men with penile curvature problems might not be able to achieve this angle, and the penis might have a top, bottom, right, or left curve. This curvature might be congenital or occur in later stages of life. The congenital form is called penile curvature, and the penile curvature that occurs in adulthood is called Peyronie’s disease.

Peyronie’s disease is characterized by fibrosis (calcification) between spongy tissues that leads to erection and tunica albuginea, and this disease might occur due to diabetes, lipid anomalies, ischemic cardiopathy, genetic diseases, erectile dysfunction, and prostate surgeries. Peyronie’s disease must be treated since it causes erectile dysfunction and problems with sexual intercourse. While some penile curvature cases due to Peyronie’s disease can be treated with medication, most can be treated with surgical methods.

What are the Symptoms of Peyronie’s Disease (Penile Curvature)?

Peyronie’s disease, which is a penile curvature problem that occurs later in life, manifests in two stages: the acute phase and the chronic phase. The acute phase, which is the initial phase, might lead to penile pain and nodules. This phase will take between 6 months and 1 year.

Untreated Peyronie’s disease in this phase will continue into the chronic phase. While the pain decreases during the chronic phase, the curvature increases, and Peyronie plaques become more visible. The curvature generally occurs at the top of the penis, since the plaques are mostly formed on the top part. In this phase, the patient might experience erectile dysfunction, decreased sexual desire, and loss of self-confidence.

The symptoms of Peyronie’s disease are as follows:

• Penile pain,
• Penile curvature,
• Nodules on the penile body/Peyronie plaques,
• Erectile dysfunction,
• Shorter penis size,
• Problems with sexual intercourse,
• Decreased sexual desire.

How is Peyronie’s Disease Treated?

The general health status of a patient is assessed prior to the treatment of Peyronie’s disease. The doctor will collect information regarding complaints about the penis, risk factors, and sexual dysfunctions and observe the erect penis. If the erection does not occur naturally, medication or a vacuum erection device is used to achieve an erection. The penis is also assessed with penile Doppler, plaque localization, and penis blood flow. Then, Peyronie’s disease treatment starts. The following treatment methods are used:

• Medication is preferred to decrease plaque formation, decrease pain, and stop the curvature. Follow-up is recommended if there are mild symptoms.
• Cutaneous supportive treatments involve vacuum devices, extracorporeal shock wave treatment (ESWT),and iontophoresis.
• Surgical treatment is suitable when medications and alternative treatments are ineffective against Peyronie’s disease. The different penis sizes due to fibrosis tissues are corrected with a surgical operation. A penile implant is used when necessary.

Is there a Surgery for Treating Peyronie’s Disease, and How is it Performed?

Surgery for Peyronie’s disease is recommended for patients who have not seen any significant benefit from medication or cutaneous treatments for 12 months. This treatment is suitable for patients with significant penile curvature that prevents sexual intercourse and is in the chronic phase. The following surgical methods are used.

• Penile plication/Nesbit: This surgical method decreases the penis size. This is recommended for patients with an adequate penis size and without significant curvature. A piece from the tunica albuginea is removed from the opposite side of the curvature (Nesbit),or plication surgery is performed without removal tunica albuginea.
• Graft surgery: This is a penile lengthening surgery. This is preferred when the penis size is inadequate and when there is significant curvature. Synthetic grafts or grafts collected from the leg are used to close the removed plaque section.
• Penile implant: If penile curvature and erectile dysfunction occur simultaneously, a penile implant is placed inside the penis.

The Recovery Process After Surgery

Depending on the surgical procedures used to treat penile curvature, the operation takes between 30–120 minutes. Surgery to treat Peyronie’s disease is performed under general anesthesia, and 1 day of hospitalization is enough. Patients are called for follow-up after 1 week, and they can have sexual intercourse after 6 weeks if there are no problems.

The incision area should be kept clean after surgery. Hands must be cleaned before touching the area, and the incision area must be kept dry. The patient must consult the doctor if there is swelling, bleeding, pain, or discharge in the operation area. Informing patients about penile shortening, numbing of the penis, erectile dysfunction, and curvature relapse before surgery is important for patient satisfaction.

Does Surgery Cause any Problems?

Surgery for the treatment of Peyronie’s disease performed to eliminate penile curvature has a high success rate. Surgical treatments, which are preferred when medication or other methods fail to treat patients with general good health, have the risks of all other surgeries.

Specifically, the operation has bleeding and infection risks. Keeping the sutures clean and sound during recovery will accelerate recovery and decrease the risk of infection. Some patients with patch procedures rarely experience erectile dysfunction. Additionally, penis size shortening might exceed the patient’s expectations. The patient is informed about these risks prior to surgery.

The Price of Surgery for the Treatment of Peyronie’s Disease

Surgery prices are commonly inquired about before penile curvature operations. Peyronie’s disease has a different prognosis among men. The factors that affect prognosis are as follows:

• Penile curvature level,
• Characteristics and purpose of the operation,
• Medical patch and devices preferred in surgery,
• Surgery duration,
• Hospital in which the operation will be performed.

Expert teams who perform surgery play an important role in the price of surgery.

When all of these factors are considered, it is not possible to give an exact price. The most important thing in the treatment of Peyronie’s is to seek an expert andrologist and treatment from a fully equipped hospital that meets hygiene standards.