Penile Reconstruction for Peyronie’s Disease
Peyronie’s disease is named after Francois de La Peyronie, who in 1743 described the acquired penile curvature feature of the disease. Peyronie’s disease is a disorder of the penis caused by scarring inside the penis that creates a significant curvature or a bent penis.
Men with Peyronie’s disease usually first notice a bent penis during erections. The penis curve can develop very gradually, but some men may suddenly wake with a significantly bent morning erection. In some men the penis curvature could be downward and be associated with painful erections, a decrease in the quality and duration of erections as in erectile dysfunction (ED).
What Causes Peyronie’s Disease?
Many of our patients with penile curvature report a history of trauma to the penis, such as an injury during intercourse. It is thought that the penis bends because, during an erection, one side of the penis stretches less than the other side. The bend occurs because one side is longer than the opposite side. This causes scarring, or plaque, that restricts expansion of one side of the penis during an erection. Peyronie’s disease is not contagious and is not sexually transmitted.
Genetic factors and trauma to the penis during sex may be a factor in Peyronie’s disease. A significant number of men with Peyronie’s disease also have Dupuytren’s contracture in the hand, a thickening in the hand that makes your fingers pull inward. Although rare, some men with can Peyronie’s disease also have Lederhose disease, contractures in the feet.
Surgical Treatment Options for Peyronie’s Disease
Surgery does not cure the disease, but is effective in straightening a curved penis. Some men have curvature so severe that penetration is impossible or causes discomfort for the sexual partner.
Some men believe that the curvature can be corrected if the plaque were removed, but simple removal of the plaque would create a “hole” in the penis. Therefore, surgery to correct curvature is not just directed towards plaque removal. Because the curvature with erections is caused by one side being longer than the opposite side, it can be corrected by making the short side longer or making the long side shorter.
Surgical treatments for Peyronie’s disease include:
Nesbit placation: Can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This can straighten the penis, but it might result in actual or perceived loss of penile length. In some men, plication can cause erectile dysfunction. This procedure is best for moderate bends in a penis due to Peyronie’s disease.
Incision or excision and grafting. In this procedure the surgeon makes one or more cuts in the scar tissue and removes some it, allowing the sheath to stretch out and the penis straighten. The surgeon will sew in a piece of tissue (graft) to cover the holes in the tunica albuginea. The tunica albuginea is a membrane within the penis that helps maintain an erection. Best suited to correcting severe curvature of the penis.
Bent Penile Implant Surgery: Penile implants are either solid or inflatable biocompatible plastic cylinders surgically implanted into the corpora cavernosum of the penis to produce a functional erection.