Treatments & Procedures - Surgical

Peyronie's Treatment

Overview

Surgical therapy should be reserved for men with persistent severe symptoms that have not improved. The plaque and curvature should have stabilized for at least 6 months before surgery is recommended. For severe curvature of the penis, precluding sexual penetration and normal function, we recommend surgery. For men with mild curvature, minimal shortening of the penis, and no hourglass narrowing of the shaft, we recommend penile plication. This involves taking a series of small tucks on the side of the penis opposite the plaque. The penis has already been foreshortened by the plaque, and this plication equalizes the length of the two sides of the penis and creates a straight penis. This is an outpatient procedure, which can be performed in less than an hour and has few side effects.

For patients with severe angulation, distinct narrowing of the girth of the penis, or profound shortening of penile length, we offer reconstructive surgery with grafting. This involves release of the scar either by incising or excising the plaque, and grafting in a substitute for the tunica albuginea to expand the length and girth of the penis. Our preferred substitution material is a graft made out of the patient’s own saphenous vein. This vein is harvested from the ankle, trimmed and reconfigured into a flat patch-graft, like a patchwork quilt. This can be then sewn into the defect of the tunica albuginea, correcting girth and length discrepancies and rendering the penis straight. While penile length is improved modestly with this approach, over 90% of men can report a straight or nearly straight penis after surgery, and most can regain sexual activity. However, risks are associated with this approach including penile numbness (less than 10%), persistent angulation (less than 5%), and severe erectile dysfunction (less than 20%).

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