Peyronie’s Disease Surgery

Peyronies disease is a very distressing condition that affects many men. Men with Peyronie’s disease have an unnatural curvature to the penis when it is erect. The penis may bend upwards or to the left or right. In worst cases, it may be impossible to penetrate a partner due to the angle of the erect penis. In many cases, sexual activity can be painful for the sufferer and/or his partner.

Surgery is often an option to cure Peyronie’s disease. It is normally considered when conservative options have failed to improve the condition, or where the curvature is such that conservative options are not going to improve the condition enough. In the national health service a procedure called ‘The Nesbit procedure’ is performed. This procedure makes the penis straight but leads to penile shortening, which can be an unattractive and unwanted outcome for many men. With the Nesbit procedure the worse the curvature the more the shortening of the penis.

There are procedures offered in the private sector that focus on length preserving aspects. The penis is made straight again with minimal loss of length. An example of these innovative approaches would the so-called ‘Stage Technique’ and ‘plaque incision and grafting’.

These procedures are performed when the disease is in the chronic phase, sometimes referred to as the stable phase. Urologists need to make sure that there have been no changes in the curvature for a period of three months prior to any surgery being carried out. Adopting this approach minimises the chances of the disease returning. It can take up to one year for Peyronie’s disease to move from the acute phase to the chronic phase.

To help assess this process it can be a good idea for patients to take photos of the penis each month during the acute phase to monitor the progression of the disease. This can be very helpful for the Urologist in the overall assessment of the case.

Peyronies disease surgery is performed under general anaesthetic and takes around two hours. In most cases, patients can go home on the same day.

The actual surgical procedure to correct Peyronie’s disease is performed under general anaesthetic. This means you would be asleep for the duration of the procedure and you would not feel anything.

This would be true of the Nesbit procedure, the stage technique, and the plaque incision and grafting technique.

Upon discharge from the hospital after such a procedure you would be given antibiotics and pain relief medication.

In the first week or two after Peyronie’s disease surgery, you should expect some discomfort. This is normal and to be expected in the initial healing phase. Your penis will be swollen and quite bruised. You will most likely have a compression dressing on the penis at first which may feel quite tight.

To ease discomfort it is important to take the pain relief medication and takes things steady in the first week or two. You must avoid all strenuous activity for up to six weeks after surgery. This includes Gym and sporting activities. If you undertake these too soon they can increase swelling and increase pain as a result. Similarly, you must avoid all sexual activity including masturbation for six weeks.

As the swelling and bruising settle down in the following weeks so will the discomfort. Those with a sedentary job may only need to take a few days off work, whilst those in more physical jobs may need to take on a week off.

If you experience increasing pain after the surgery you should contact your Urologist as this could be a sign of infection.

Most patients who undergo Peyronie’s disease surgery tolerate the post-operative discomfort without any problems. It is very important to follow the advice of the Urologist to the letter after the procedure as some of this advice will be to help to ensure the most comfortable recovery possible.

Guys with Peyronie’s disease notice an unnatural curvature to their penis when it is erect. When the penis is flaccid this curvature may not be noticeable.

Most guys have never heard of Peyronie’s disease when they encounter this condition. To see their penis suddenly bending can be quite shocking and upsetting. It affects relationships and in the worst cases can make sexual intercourse virtually impossible.

Peyronies disease goes through two phases, known as an acute phase and a chronic phase.

In the acute phase, there is often pain during an erection and the start of bending of the penis. The penis may bend upwards towards the body, or left or right. In this acute phase, the patient can just wait and see how the disease develops over the following nine to twelve months before it enters the chronic phase.

However, there is the option to try conservative treatments in this acute phase to attempt to limit the extent of the curvature and promote the healing of the damaged tissues.

This conservative treatment may consist of therapies such as tadalafil medication which oxygenates the penis by encouraging blood flow. This helps in the healing process. Alongside tadalafil, other therapies include a vacuum pump and traction device to help with the remodeling of the penis. It cannot be determined how much these therapies will help, time will tell, but in the acute phase, there is evidence that they do help and patients generally feel better that they are making an effort to improve the situation.

When the disease enters the chronic phase then an assessment will need to be made of the extent and impact of the curvature. If the conservative therapies have helped, it might be that the patient can live with a moderate degree of curvature without any major impact on their sexual performance. If however, the curvature has worsened over the previous year, surgery will need to be considered to make the penis straight again. Indeed in significant curvature, this is really the only option. The NHS carries out a procedure known As ‘The Nesbit procedure’ which will straighten the penis but leave it shorter than before. Now there are more advanced procedures available privately that straighten the penis whilst protecting its length. Such procedures include the so-called ‘Stage Technique’ and ‘plaque incision and grafting’.

If the penis is left untreated at the chronic phase with a significant curvature, there is a risk of a penile fracture.

Peyronie’s disease surgery is common in cases of significant bending of the penis, usually where more conservative treatments in the acute phase have failed to have any reasonable impact.

In Peyronie’s disease the condition moves from an acute phase into a chronic, or sometimes called, a stable phase.

This transition is very important when considering the timing of Peyronie’s disease surgery. In the acute phase the patient will notice a progressive bending of the penis. This bending may be upwards towards the body, or it may be to the left or right. Urologists usually advise patients to take photos of the penis at the same angle once a month, to help monitor the changes in the penile curvature.

The disease tends to move into the stable phase at around nine to twelve months. The patient will notice no change in the curvature. The Urologist will want to see a period of three months with no changes to the angle of curvature before considering Peyronie’s disease surgery. This is very important because if the surgery is carried out too soon, for example when the disease is in the acute phase, there is a higher risk that the disease may return after the surgery.

By waiting until the disease moves into the stable phase there is much less risk of the curvature returning after surgery. It should be mentioned that there is a very small risk of a recurrence of Peyronie’s disease after the surgery, but this is rare.