Peyronie's Disease Surgery
Penile Plication
Penile plication is a reconstructive procedure used to straighten the penis in men with Peyronie's disease and significant curvature that interferes with sexual activity.
Rather than removing the Peyronie's plaque, plication places sutures on the opposite side of the penis to shorten the longer side and definitively straighten the erection. It is generally best suited to men with adequate erectile function and relatively preserved penile length.
Plication is highly effective for curvature correction, with published series generally reporting 90% or greater improvement in curvature. The primary tradeoff is potential penile shortening, which varies depending on the degree of curvature and surgical technique. Some men may also notice palpable sutures or residual/recurrent curvature.
Recovery typically involves several weeks of healing, with sexual activity generally avoided for approximately 4–6 weeks. Risks include infection, bleeding, altered sensation, residual curvature, recurrence, palpable sutures, and penile shortening.
Extratunical Grafting
Extratunical grafting is a reconstructive technique designed primarily for men with Peyronie's disease causing significant indentation or hourglass deformity, particularly when erectile function is otherwise preserved.
Rather than cutting into the erectile chambers or removing the Peyronie's plaque, a graft is placed externally over the affected portion of the tunica to provide structural support and improve the contour of the penis. This approach is intended to correct deformity while minimizing disruption of the erectile tissue.
Early clinical experience has demonstrated good correction of indentation and preservation of erectile function in appropriately selected patients. Because it is a reconstructive technique, outcomes depend on the specific deformity and surgical anatomy.
Recovery generally involves several weeks, with sexual activity delayed until healing is complete. Risks include residual deformity, recurrence, altered sensation, swelling, infection, and erectile dysfunction, although the technique is designed to minimize disruption of the erectile bodies.
Plaque Incision/Excision With Grafting
Plaque incision or excision with grafting is a more extensive reconstructive procedure used for men with severe Peyronie's disease, particularly those with significant curvature, indentation, hourglass deformity, or substantial loss of penile length who have adequate erectile function.
The Peyronie's plaque is partially opened or removed to release the curvature, and a graft is placed over the resulting defect to restore the shape of the tunica surrounding the erectile chambers.
The procedure can provide substantial correction of severe curvature and may better preserve penile length than plication in appropriately selected patients. However, because the erectile chambers are more extensively manipulated, there is a greater risk of postoperative erectile dysfunction than with plication. Men with ED after grafting surgery often go on to need penile implants down the line.
Recovery generally requires several weeks, with sexual activity delayed for approximately 4-6 weeks or until adequate healing. Risks include erectile dysfunction, recurrent curvature, altered sensation, infection, graft-related complications, and changes in penile length.