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Peyronie's Disease

Click for Peyronie's
Before and After Photos

 

CONSENT FORMS:
“Tutoplast” Cadaveric Pericardial Graft   |   Plication

Peyronie's disease, named after the french surgeon to King Louis XV, is a restricting scar or plaque that exists in the lining of the erectile bodies resulting in a tethering of erections ("bent spike syndrome"). The cause is now thought to be repetitive trauma. An unappreciated example would be female above trauma which may occur after the penis momentarily slips out of the vagina. Autoimmune basis for plaque has also been ascribed. Peyronie's disease may co-exist with Dupuytren's flexion contractures of the hand.

Disorders unassociated with plaque, yet producing erectile deformity include "lateral penile curvature" seen occasionally in adolescents when unilateral enlargement of one erectile body (typically the right) causes the penis to deviate to the left and "chordee, without hypospadias". In the latter, the erect penis angulates downwards secondary to a restrictive developmental anomaly of tissues surrounding the distal urethra. As with Peyronie's disease, these deformities can be corrected by removing a wedge (s) of tunica albuginea (the lining tissue of the erectile bodies) on the opposite side. When the tunica is resewn, plication of the edges of resected wedge results in some shortening of the uninvolved side to counter the tether on the opposite side. You may anticipate that your erect length following surgery approximates your stretched penile length now. If this is not acceptable, some patients will opt for a simultaneous or staged lengthening procedure to be performed after surgery.

peyronies disease
pre-op, curves to the left
peyronies disease
intra-op.Curved corrected and verified to be
straight before closing
peyronies disease
pre-op.  Curves downwards
peyronies disease
intra-op confirmation that penis is now perfectly straight
peyronies disease
subsequent post-op photo of same patient
peyronies disease
pre-op, marked dorsal (upwards angulation)
peyronies disease
intra-op, neurovascular bundle lifted, plaque removed,
pericardial patch inserted, perfectly straight penis
peyronies disease peyronies disease
pre-op curvature views, unable to penetrate, also some degree of impotency
peyronies disease  peyronies disease
post-op with curvature corrected and penile prosthesis installed

 
pre-op showing a 55 degree angulation, intraoperative correction with multiple parallel suture plication showing straightened result

peyronies disease
letter from grateful wife of another patient who had a pericardial patch



 
year 2013, downward angulation corrected with plication.

 

 

The course of Peyronie's disease varies from patient to patient. It may stabilize and evolve no further, usually after subsidence of the inflammatory stage. Usually within 3 to 6 months, the disease will run its course. Certainly this would be an ideal time for initiation of more conservative measures such as Vitamin E or intralesional injection of Verapamil. Other methods described have included the use of Collagenase, steroids, and ultrasound therapy. In general, medical therapies tend to soften the plaque and reduce pain, but are less efficaceous with correction of angulation. Verapamil injections have been recently challenged as being no more effective than simple sterile saline injections, and the mechanism of action has been postulated to be a multitude of needle sticks breaking up the plaque.

Verapamil cream may be helpful, but no meaningful statistical data relating to correction of curvature has yet to be confirmed.

As surgical procedures are not indicated when there is a process in evolution, it would be wise to postpone such procedures until a period of stability has been achieved for 3 months, and regardless certainly no sooner than 6 months following onset. Clearly surgery is not absolutely necessary when the bend does not interfere with penetration.

When indicated, surgical option include:

A. Contralateral plication (shortening of the normal side). This approach has the advantage of lower incidence of erectile impairment. Candidates for plication include men whose stretched penile length is satisfactory, men with borderline erectile performance, older men, and smokers who have higher incidence of latent erectile impairment.

B. Removal or incising the offending plaque with graft insertion restores length to the affected side. This approach is best suited for potent men with severe penile shortening as a result of Peyronies often associated with a extreme curvature (i.e. greater than 60 degrees). Patients who undergo plaque release surgery must be counseled that at times because of insinuation of the plaque into normal tissue (spiculation), its entire removal may not be advisable. Following surgery, there may be a reduction or transient loss of normal sensation.  This usually resolves in 6 months, as peripheral nerves have remarkable powers of regeneration.  Cadaveric pericardial grafts in our practice have replaced venous patch grafts.  Their compliance has been an invaluable asset to restore length.  When compliant grafts are used to circumferentially replace fibrotic tissue, length gains up to 3" have been reported over 18 months using a vacuum erection device.

Patients who have simultaneous erectile impairment in Peyronie's disease are ideal candidates for simultaneous insertion of a penile prosthesis and lysis of the plaque. (Reference: Reed, H.M.; Simultaneous Inflatable Penile Prostheses Insertion and Corporoplasty for Septal Chordee Attributable to Peyronie's Disease. Annals of Plastic Surgery, 31:154-158, 1993)

Comprehensive surgical fee for the correction of Peyronie's which does not include adjunctive penile lengthening or prosthesis surgery is $6,200.00.  If performed with insertion of Tutoplast graft for restoration of length and correction of curvature, $7,700. Consultation is $250.

Most insurance companies will fund for evaluation and treatment of Peyronie's disease.  Please check with your carrier for an explanation of your benefits.


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THE REED CENTRE specializes in penis enlargement surgeries, including penis lengthening or phalloplasty and
penis girth enhancement.

Penis Enlargement Surgery:

Penile lengthening techniques or phalloplasty have been described in the urological literature for at least 40 years.  Average penis erect lengths measured with a ruler placed gently on the pubic skin vary from 5 3/8 to 5 3/4 inches depending upon the city and year the study was performed.  Many men with below average penis measurements may still appear normal and function quite well.  For this reason, penis enlargement / penile enhancement / phalloplasty should be considered an elective procedure.  

Harold M. Reed, M.D., F.I.C.S.
1111 Kane Concourse
Bay Harbor, Florida 33154
Florida  (305) 865-2000
infos@penisdoctor.com

 

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